Staff Referral to School Counselor 2023-2024

School Counselor Assignments:

Year 1: TBA- 44831
Year 2: Gaylene Gay- 44832
Year 3: Laura Dahlin-Bracciale- 44836

Year level

Year level Year 1 - TBA Year 2- Mrs. Gay Year 3- Ms. Bracciale
Is this request an emergency (harm to self or others)?

Is this request an emergency (harm to self or others)? No Yes- If yes, please do not fill out this form. Immediately call the appropriate year level school counselor (or available counselor). If the counselor is not available, please call your grade level administrator or Corporal.
Student Name Student Name First Last
Your name Your name First Last
Student Number
Reason for referral

Reason for referral Academic Peer Personal
Brief description of why you are referring to the counselor.