Referral Forms

Counselor Referral Process

Ways to refer:

• A student may refer themselves

• A teacher may refer a student

• A parent refer his/her child

• A person on campus can refer a student

Parent Referrals:

• Fill out Parent Referral Form.

• Email or call counselor to request an appointment with counselor.

Reason to make a referral:

• You have concern about a child's academics.

• You have a concern about your child's behavior.

• You have concerns about your child's relationships with peers.

• You have concerns about your child's personal development.

• You have concerns with your child's reactions to changes within the family that may be effecting his/her learning at school.

Why should it be done:

• Provides students with more one on one help, support, and intervention

• Increases specificity of interventions and supports and tailors them to the student

• Increases privacy for the student

• Removes the student from the situation or circumstance to discuss solutions to it

• Reduces anxiety and pressure on student

• Provides the student with the full attention of an adult

• Makes student feel secure

• Allows an adult to give a student undivided attention

• Frees the teacher up to continue teaching the rest of the class without having to stop to speak or counsel a student in the hall or away from the class

When should it be done:

• When students are over emotional and cannot calm down in an appropriate and brief amount of time

• When a student’s needs are greater than those the teacher can provide in the classroom setting

• When a student requires more support and attention to address or solve a problem, issues, etc

• When students need more specific and individualized help, solutions, and plans to address issues

• When a student needs more privacy than a teacher can provide in the classroom

How should it be done:

• Counselor referrals may be planned or spontaneous

• For planned referrals, have the student set up a day or days and times to meet with the counselor ahead of time and provide the student with reminders

• For spontaneous referrals where an incident happens and the student unexpectedly requires counselor support, send the student down to the counselor with a note briefly explaining what happened, or send the student down and call and explain to the counselor the issue.

  • You may walk the student down or send another student to walk down with the student to the counselor

  • The counselor may also come to the room to retrieve the student