ACE Counselling Referral Form 2026/2027
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I have understood the information above and consent that the information I provide here will be seen by the Wellbeing Team and shared with the college Safeguarding Team if required. *
Section 1: Referral Type
What type of referral is this? 
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If you are making a professional referral please provide your full name
Section 2: Student Details 
Student B Number *
First Name:  *
Last Name: *
Date of Birth  *
MM
/
DD
/
YYYY
Email Address: 
Telephone Number: *
What campus are you based at?  *
Please briefly describe what you would like support with

When are you available to be contacted and attend counselling sessions?

Please tell us the days and times that work best for you.

 Please note that we do not offer appointments on Tuesdays, evenings, or weekends.

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