DePaul College Prep Referral Form

Please use this form as the formal process for counseling and academic referrals. 

  • The social/ emotional referral component of this form can be completed by ANYONE. 

  • If you are a parent/ guardian who has an academic concern, please email Briana O’Donnell or the student’s counselor and/or learning specialist. 

Please be as descriptive as possible, so that we can accurately connect each student to the appropriate interventions.


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Email *
What is your name? (person completing this form) *
What is the name of the student you are referring? *
What grade level is the student you are referring? *
Who is the student's counselor? (If unknown, please select Ms. Lewis) *
Do you believe this person is an immediate threat to themselves and/or others in the DePaul College Prep Community? Are they making/have they made comments or threats of committing suicide, other forms of self harm or harm to others? 
 *
What is your relationship to the referred student? *
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