Teacher Referral for Counseling Services
Please fill out this form if you need to refer a student for counseling. I will respond to these, but if it is an emergency please find me or call the office.
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Student name: *
Referring Staff: *
Reason(s) for Referral: *
Required
Please list anything you would like me to know.
Are parents/guardians aware of the above concern? *
What is a good time to pull the student from class? (Multiple options are best!) *
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