HOA Counseling Referral 2025-26

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Students, staff, or parents/guardians: Please use this confidential form to request to speak with one of the School Counselors, Ken Ollis (K-8) or Danielle Jones (9-12), or the Wellness Counselor, Annette Snyder (K-12).

If this is a mental health emergency please contact the Washington County Crisis line/Hawthorne Walk In-Center at 503-291-9111 (24/7). You may also call the National Suicide Lifeline at 988.

Name of referring person (first and last) *

Student name (first and last) *

Student Grade *

Student ID (if known)

I am: *

A student making a request for myself

A parent/guardian who has a concern about my student

A staff member who has a concern about a student

Other:

Please explain your concerns (please be specific) *

Email address *

Phone Number

optional but preferred

How do you prefer to be contacted?

Phone

Clear selection

FOR STAFF ONLY: What steps have already been taken? (talked to student, talked to parent, academic support, ect)

Submit

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