Referral Form
This form is intended to help connect students with a school based mental health professional. Counselors: Guy Gordan and Rebecca Ewald; SEL: Kari Gray
* Required
Email address
*
Your email
Who are you referring?
*
Your answer
Was there anyone else involved? (names here)
*
Your answer
From your perspective, what happened?
*
Your answer
What was your response at the time? What did you try so far?
*
Your answer
When would you like a response by?
*
Today/ASAP
This week
Soon-it's ok to wait until next week
If you find yourself or another in a crisis these resources are available and you are encouraged to use these in addition.
Jefferson Center
1-844-493-8255 or Text TALK to 38255
A local walk-in crisis center is located at Jefferson Center’s Crisis & Recovery Center at
4643 Wadsworth Blvd., Wheat Ridge, CO 80033
https://www.jcmh.org/emergency-crisis-services/
Crisis Textline
Text: 741741
Or Facebook Messenger
https://www.crisistextline.org/
911
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