Parent/Guardian Request for Counseling Services

Dear Parent/Guardian,

Your child has been referred for group/individual counseling by a classroom teacher, an administrator, parent, or self-referred.  School counseling is short-term and problem-solving oriented.  It is usually recommended for a student to improve a specific behavior, effective communication skills, conflict resolution, interpersonal relationships, decision making skills, anger management, or other issues that are impacting a student’s performance in school.  

Confidentiality is important to develop a positive counseling relationship and is only broken in cases of indicated criminal activity or threats of harm to himself/herself or others by the student.

If you have any questions regarding your child receiving counseling, please contact
Mrs. Farrah “Jazzy” Jones at ( or call/ text 240-489-1831.

*School counselors are not therapists and do not provide therapy or psychological diagnoses.  A list of local counseling therapists is available if you are considering the need for an evaluation, therapy, and/or family counseling.  

Kind Regards,
Mrs. Jazzy

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Email *
First Name of the Student *
Last Name of the Student *
Grade Level *
Teacher *
Some of the topics that are often addressed in individual or group counseling are shown below. Please place a check mark next to the topic(s) that you feel your child might benefit from. *
Please provide further details about your concerns *
Please provide the best contact information below (phone # or email) and the best time to talk *
Additional Comments or Concerns
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