2019-2020 Counselor Referral Form
This form is to refer scholars to their counselor. Counselors are Mrs. Callahan at the middle school and Mrs. Kennedy at the elementary school. Please only submit the form once per student for a single concern.
Initial Counselor Referral
Counselor Response (counselors ONLY, please)
Scholar's Name (First and Last)
The problem is about...
Tell us about the problem...
If you would like, please provide more information about the problem.
Needs the counselor...
Right away = BIG problem
RIGHT AWAY (within 24 hours)! **If this is the case, please call the front office admin after completing this form to alert us, as we typically do not check form responses until the end of the school day.
Sometime in the next couple of days
Sometime in the next week
First and Last Name of Person Making Referral
Email Address of Person Making Referral
Please enter your email address. This email address will be used to send any response from the counselor, if applicable.
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