Student Counseling Referral
Please fill out form completely and a Counselor will contact you.
 If this is a TRUE emergency please contact Counselors by phone or stop by the Counseling office.

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Student's First name *
Student's Last Name *
School ID Number *
Grade *
Who is your Counselor?
What letter does your LAST NAME begin with?
Clear selection
Reason to see a Counselor *
Please select from an option below. If "Other" please explain.
I need to see you...
Right away = BIG problem
How do you prefer to have your counselor contact you? *
How are you currently attending school?   *
Is this an anonymous request?
Telephone Number *
Clear form
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