Parent / Guardian Referral Form
A Professional School Counselor is available for students, parents, faculty and staff by appointment. Please call (417) 678-2251, stop by the Counseling Office, or email,, or to schedule an appointment.
Email address *
I am requesting that the School Counselor talk with my child *
Student Last Name *
Your answer
Student First Name *
Your answer
Student grade level *
Your name *
Your answer
Relationship to student *
Your answer
Your phone number *
Your answer
Best time to contact you *
My child's strengths include *
Your answer
My primary concern *
*Check all that apply
Additional information regarding your concerns
Your answer
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