Anza Student Referral to Counseling - Parent Request
Use the form below to refer a student to the counselor for school-based counseling. If your student is at risk of harming themselves or others, please do NOT use the form, and instead call 9-1-1.
Student Name *
Your answer
Your name *
Your answer
Reason for Referral *
Choose one or more areas for concern
Please provide explanation of your concern. *
Your answer
When are some available times for me to contact you? *
Your answer
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