Counseling Session Reservations 
If you are concerned about a student, would like to refer a student, or believe your student would benefit from receiving short term counseling services, please fill out this form. 
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Student Full Name *
Relationship to the Student *
Have parents/guardians been notified of this referral? 
(If you are a parent/ legal guardian please select N/A)
 *
Areas of need/ concern
Level of Concern *
Type of Services
Please indicate the type of counseling you feel would best fit the students needs
 *
Required
Please share additional concerns or information for the referral:
E.g. Are there any contributing factors/ important information for counselor to be aware of, have any interventions been implemented up to this point, are there any academic concerns currently? 
Contact Information *
Please provide preferred contact method so that the School Counselor can follow up with any additional questions if needed
Questions and Comments
Please leave any questions and comments you may have here. The School Counselor will get back to you as soon as possible
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