Referral Form
Please answer the following questions and submit.

School counselors do NOT monitor digital platforms 24/7. Digital communications, including email, are not to be used for emergencies. In the event of a life-threatening emergency or injury, call 911 or a Crisis Line immediately or go to the nearest emergency room.

Tuscarawas  24/7 Crisis Hotline 330-343-1811

24/7 National Crisis Text Line - Text HOME to 741741

If suspected neglect or abuse of a child call, JFS Child Protective Services - 330-339-7791

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Email *
Last Name *
First Name *
Are you a... (check 1) *
Grade Level (check 1) *
Contact Email & Phone Number *
Your Primary Area of Concern (check 1) *
Reason for Visit (check all that apply) *
How do you want to be contacted? *
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