Social Worker Referral

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If you are aware of a Green Canyon student who may need extra support, please fill out the information below. The social workers at the high school will get in touch with you prior to meeting with the person you are referring for a check-in to determine how the social work team can provide services or support to them.

Thank you for supporting this person and helping us to support them.

Email *

Record my email address with my response

Your Name: *

Email: *

Phone Number:

I am a: *

Grade Level of student:

Name of student being referred: *

I think this student could benefit from:

Accessing the Pack Pantry to get food or clothes

Individual or group counseling with a Social Worker

Weekly academic check-ins with someone on the counseling team

Other:

Please tell us a little bit about this student and why you are referring: *

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