Student Referral Form

Parent Referral Form 

Teacher/Staff Referral Form 

How can I refer my child or student to the School Counselor?

Parents, teachers, and students can make referrals in many different ways. When referred, students are seen individually or in a small group. Usually, the student and counselor work together to establish an individual goal related to the student's initial concern. 

Methods of Referral 

• • Parents and teachers may refer students by contacting me either by email, phone, or the online Google Form. 

  • Students may request a meeting with me in several ways:

    • Fill out a request form and leave it in the box outside my door

    • Complete the Google Form online

    • Come to my room and see if I am available right then

    • Ask me when they see me; we can either schedule a time or talk right then

    • Ask a teacher to email me

    • Ask their parent to call or email me requesting a time to meet

Confidentiality 

While confidentiality is an inherent part of the counseling relationship, children are always encouraged to share it with their parents.  

Limits of Confidentiality:

• Information will be kept confidential unless disclosure is required to prevent clear and imminent danger to the student or others, or when legal requirements (court order) demand that confidential information be revealed.