BH School Counselor Request Form 2025-2026

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If you wish to have a student seen by our school counselor, please fill out this form. The responses to this form will be checked once a week. If you have something more urgent to inform the school about, please contact the school's main office during business hours at 609-492-7411. (If your child is in crisis, please dial 988 for support and 911 for emergencies).

Email *

Your First and Last Name (Person Making the Request) *

I am a: *

Parent/Guardian

Staff Member

Student

Students First and Last Name *

Grade *

Preschool

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Kindergarten

Reason/s for counselor request *

Adjustment/Transition

Anger

Attention Span

Anxiety/Nervousness

Confidence/Self-Esteem

Divorce

Effort/Motivation

Friendship/Peer Interactions

Grief-Loss/Death

Personal Hygiene

Sadness/Depression

Self-Control

Study Skills

Other:

Required

I would like the counselor's next step to be:
*

Set up a time to meet with me to further discuss this referral.

Observe the student in the classroom setting.

Meet individually with the student.

Other:

Submit

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