School Counselor Referral Form - Individual
Please complete as much of this information as possible to refer students to the counseling office.
Note: These referrals are NOT reviewed by a counselor after 4:30 pm or on weekends.
First & Last
What is the nature of the concern?
Please elaborate on the issue with concrete examples or situations. Feel free to add any information that you feel would be helpful to the counselor as she works with the student.
I would like for you:
To observe this student
To discuss this student with me
To talk with this student today (this is urgent!)
To talk with this student this week
To meet with me and this student
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