Get Online School Counselor Referral Form

Completing the Online School Counselor Referral Form is a straightforward process that enables concerned individuals to refer a student for counseling services. This guide provides detailed instructions to help you navigate each section of the form with ease.

Follow the steps to effectively complete the referral form.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the date received in the designated field to document when the referral was submitted.
3. Enter the student's name, including first and last names, along with their grade and homeroom teacher's name.
4. Provide the parent or guardian’s name and contact numbers, including home, work, and cell phone numbers.
5. Record the student's date of birth in the appropriate field.
6. Indicate who referred the student by checking the appropriate box (e.g. teacher, self, parent, or other).
7. Specify with whom the student lives by filling in this section.
8. Outline the reasons for the referral by checking all applicable boxes related to the student’s concerns.
9. Clarify the referral problems or history by providing detailed information in the section provided.
10. Document any actions taken by the person making the referral in the designated area, and attach any relevant intervention copies if applicable.
11. Indicate whether the parent or guardian has been contacted about the concern, providing the date and a summary of the outcome.
12. Describe any other services the student is currently receiving (e.g. Centerstone or out-of-school counseling).
13. Sign the form in the designated signature area and provide the date of referral.
14. Once all information is filled out, review the form for accuracy, and save changes or download the form for submission.

Complete your Online School Counselor Referral Form online today to ensure timely support for students in need.