Counseling Referral Form

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Please use this form to request to see a School Counselor or to make a referral to a School Counselor. Your response to this form will be seen within 2 school days and your School Counselor will follow up with you. Please note: this is not intended to be used in the case of an emergency. If you need immediate help, please call 911 or Region Ten at 434-972-1800.

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