School Counselor 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.