Individual Counseling Description
Parent(s): One of my jobs as a school counselor is to teach children the skills that will help them cope with life’s difficulties.  The aim of the school counseling services is to help students have more effective education and socialization within the school community. Possible counseling topics are coping with changes, transition, self-esteem, friendships, relationship issues, study skills, stress management, fears or worries, academic progress, conflict resolution, social skills, adjustment to school or culture, divorce etc. During Individual Counseling I work one on one with the student to help him or her with their own personal needs. During group counseling I will work with 3-5 students who all share similar needs. We may use books, videos, crafts, toys, worksheets, or other methods to learn these skills.  

If you would like your student to meet with the counselor, please fill out the bottom portion.

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Informed Consent
I give my child permission to work with the school counselor in an individual or group setting. I understand the school counselor will keep information confidential with the exception of stated or suspected danger and/or abuse to the student, self or others. Because these services are provided to minor children in the school setting, I, the parent, understand that the school counselor may share information with parent(s)/guardian, the child’s teacher, administrators or school personnel who work with the child on a need-to-know basis, so that we may better assist the child as a team. I am also aware that the number of counseling sessions may vary due to the student’s presenting issue(s) and that I will notify the school in writing if I decide to terminate the counseling relationship at any time. I have read and understand the above statement.
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Student name and grade *
Reason for counseling. *
Parent/Guardian name and contact information *
Date *
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