Caregiver Referral
Thank you for reaching out to your school social worker. Be aware that I do not check email except during school hours. If this is a crisis or emergency call 911 or go to your local emergency room.

School social workers cannot provide therapy or treatment for you or your family, but we can assist you with making the appropriate referrals to community agencies.

Confidentiality- Information students share with the school counselor is confidential. The student’s right to privacy is guarded as much as permitted by law, ethics, and school policy. The school social worker is obligated to break confidentiality when there is potential harm to the student or others, concern of neglect or abuse, or a court of law that requires testimony or student records.

At times, the counselor and school-based staff (teacher, social worker, principal, etc.) will need to exchange information about your child (how are they coping in class, strategies to help, etc.) All communication will take place only on a need-to-know basis.

E-mail transmissions may contain confidential health information that is privileged and legally protected from disclosure by the Health Insurance Portability and Accountability Act (HIPAA). This information is intended only for the use of the individual or entity named in the email. If you are not the intended recipient, you are hereby notified that reading, disseminating, disclosing, distributing, copying, acting upon or otherwise using the information contained in this e-mail is strictly prohibited.

Student Name *
Parent/Guardian Name *
Best Phone Number and Time of Day to Reach You *
Names of siblings
What are your concerns? *
Required
Please provide a brief description of your concerns/needs
How can we help? *
Required
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