Referral for Alta Behavior Health Counselor 2019
Please submit this form to refer a student for counseling services at MCCTC & Valley STEM.
Last Name of Student
First Name of Student
Mechling (Canfield, Campbell, Jackson-Milton, Lowellville, Poland, South Range, Springfield, Struthers, Youngstown and all OE schools
Sullivan (Austintown, Boardman, Sebring, West Branch and Western Reserve)
MCCTC or STEM
Date of Birth
Reason for Referral
Who is making referral?
Please list any other important information you would like to share:
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