Referral Form: Parent '22-'23

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School Counseling is a short-term service delivered to individuals or groups to help students function more effectively in the classroom and with their peers. The relationship between a student and their counselor carries communication privileges and rights to confidentiality. Any information shared by your student will be kept confidential. There are times when students divulge information that I feel should be shared with parents. I will encourage them to do so or request permission to discuss the matter with a parent or guardian myself. I will do this anytime I feel it is in the best interest of your student. There are also several situations in which I am required by law to share details of a counseling session with the appropriate authorities.

Jenny George, PPS, APCC9636
School Counselor
jennifer.george@santeesd.net

* school counseling is not on-going mental health therapy. For serious concerns please contact the school counselor for outside counseling resources.

Your first and last name AND relation to student: *

Student Name: *

Student Grade: *

What are your concerns: (You can select more than one.) *

Academic

Social

Emotional

Basic Needs

Other:

Required

Briefly describe your concerns: *

Please share any interventions (i.e. seeing a counselor outside of school, behavior chart, etc.) you have already put in place, and whether they were successful or not. If none, then write NA *

Please list 3 or more strengths your student has: *

Please provide the best number and email to contact you with: *

Anything else you want to share?

Submit

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