Counseling Parent/Teacher Referral 

There are times when a student may need to talk with the school guidance counselor. Whether the need is understanding emotions that are too hard to process alone, friendship issues, bullying, conflict resolution, or helping with academic guidance, the school guidance counselor is a great tool to help guide the students when needed. 

Please use this form to refer a student. If you have further questions please reach out via email to jacie.burkhead@go2ccs.com (if you are a student, please see the office staff or email jacie.burkhead@go2ccs.com). 


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What is your name/association with the student?  *
What is the student's name you would like to refer?  *
On a Scale from 1- 5 please choose the level of immediacy needed for the student's situation.

If this is a true, present emergency contact the guidance counselor and/or staff at CCS immediately. (If there is an emergency at home, parents should call 911.)  *
1 (helpful)
2 (necessary)
3 (important)
4 (urgent)
5 (emergency)
Row 1
Other relevant information: 
Please provide your contact information:
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