Mr. Miller's School Counseling Page
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School Counselor Referral Form

These referral forms are only meant for students at East Fannin Elementary
EFES Teacher Referral Form
EFES Student Self Referral Form
EFES Parent Referral Form
Counseling Referral Process
Ways to refer.
  • A child may refer themselves.
  • A teacher may refer a student.
  • A parent may refer his/her child.
  • A staff person on campus can refer a student.
  • A physician may refer a student.

    For a parent/ counselor meeting.
  • Call the school counselor to set up an appointment
  • Send a note or an email to the counselor requesting contact

Reasons for a referral.
  • You have concerns with your child's attitude toward school.
  • You have concerns with your child's academic growth.
  • You have concerns with your child's relationships with peers at school.
  • You have concerns with 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
  • Be vigilant of students abusing counselor referrals as a means to avoid work or something else
    • If you suspect students are abusing the intervention, use the student's agenda where they have to check off each time they see the counselor, limiting them to a certain number of visits per period, for example 3 visits a week or 1 visit a day, etc.
Sample: Teacher referral form for school counseling
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  • Home
  • What do School Counselors do?
    • Kindergarten BOY Lessons
    • 1st Grade BOY Lessons
    • 2nd Grade BOY Lessons
    • A Note from the Counselor
  • School Counseling & Art Therapy
  • Classroom Management Strategies
  • PBIS- Positive Behavior Intervention & Support
    • PBIS Booster Training Tier I
    • PBIS Lesson Plans
    • PBIS Tier I Classroom Effectiveness
    • PBIS Tier I Resources
    • PBIS Tier I Behavior Accommodations
    • Tier II- Effective Interventions
    • Tier II Resources
    • PBIS Universal Screeners
    • PBIS at Home
  • SEL & Mindfulness
    • SEL Brochures K-2 Grade
    • SEL Brochures 3-5 Grade
    • Mindfulness Classroom Activities
    • Mindfulness Videos
    • Rocket Kids (SEL)
    • Social Skills PowerPoints
    • Social Emotional Learning Videos
    • Social Emotional Learning Worksheets
    • Social Emotional Learning Read Aloud >
      • Social Emotional Learning Read Aloud
    • BrainPOP SEL
    • Subscription Based- SEL Resource
    • Classroom Based SEL Lessons
  • FBA & BIP
    • FBA & BIP Videos
    • Step 1: Gathering Information
    • Step 2: Target Behaviors
    • Step 3: Collecting Data >
      • ABC Data Collection Tutorial
    • Step 4: Data Analysis
    • Step 5: Behavior Intervention Plan
  • Child Abuse Lessons
  • Snack In a Backpack
  • Peer Mediation 3rd-5th Grade
  • Chess Club
  • Newsletter
  • Test Taking Skills
  • Counseling Survey
  • Counseling Referral Form
  • Bullying Referral Form
    • How to Unmake a Bully Videos
  • Red Ribbon Week: Drug Prevention Lessons
  • Lunch Bunch
  • Counseling Lessons
  • Mindfulness and Your Lizard Brain
  • Guidance PPTS
  • Individual Counseling
  • Group Counseling
  • Career Guidance Information
    • Career Lessons and Resources
    • Paws In Jobland
    • Supplemental Career Lesson Materials
  • Mindsets & Behaviors
  • Community Resources
  • DFCS/ Mandated Reporting
  • EFES Student Council
  • Parent Resources/ Articles
  • Second Step
    • Kindergarten Second Step
    • 1st Grade Second Step
    • 2nd Grade Second Step
  • School Counselor Schedule
  • How the School Counselor can help
  • Frequent School Counseling Topics
  • It's Elementary! School Counseling Blog