Referral to Molly Wilson
To make a referral or request an appointment with a counselor, please fill out the information below. If this is an emergency (suicidal thoughts or actions, fear of harm by self/others, etc.) please go to the counselor or other trusted adult immediately. If this is an emergency outside of school hours, call 911.
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I am *
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Student's Last Name *
Student's First Name *
Name of Referring Person (if not self)
Your Contact Email
Your Phone
Best time to contact you or make an appointment?
Priority *
Reason for appointment *
Please check all that apply
Required
Please briefly explain if you can:
"I'm struggling with homework", "fight with friend", "scholarship questions"....
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