CES Staff School Counseling Referral
Teachers/Staff can fill out this form to request that a student is seen by one of our school counselors.
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Teacher/Staff Member Making Referral *
Student's Name (First and Last) *
Student's Grade *
Student's Homeroom Teacher *
Reason(s) For Referral (check all that apply) *
This Student Needs to See You... *
Comments - Please give any additional information that would be helpful to know before meeting with the student. *
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