Counseling Referral

Please use this form for referrals to the school counselor. You may also email this information. In case of an emergency please call 911. If there are immediate non-emergency concerns of risk/crisis for the student or another family member, please ensure to first follow all mandated reporter laws and then contact Sr. Josephine directly at cell phone number 903-202-0760.

Thank you,
Sister Josephine

Counseling Referral Form

Name of Submitter

Student information

Student Name

Student Grade Level

Is the student self referring? Yes No

Please provide a brief reason for referral

This can be brief and not too much detail - I will follow up in person for additional details. If the student is self-referring and did not disclose a reason then leave blank. Thank you!

Referral Description

For staff only

If the student is not self-referring, and you are recommending the student for counseling, have you mentioned this referral to the parent(s)/guardians? Yes No N/A (Student Self-Referral)

Security Check - To verify you are not a robot, please answer this question:

What is the abbreviation of Michigan State University?

Counselor

Sister Garrett

School Counselor

Phone: 903-202-0760

Send me a message

Counseling Referral