School Counseling Office
The Elementary School Counselor
Stokes County Elementary School Counseling Programs Mission and Vision
Comprehensive School Counseling Program
Guidance Curriculum
Covid 19 Resources
Relax and Destress
Referral Forms
Student Self Referral Form
Staff Referral Form
Parent/Guardian Referral Form
Parent Links
Summer Enrichment Opportunities
Parent/Guardian Referral Form
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Indicates required field
Student Name
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First
Last
Parent Name and best Contact (phone/email)
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Please contact my child
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After Talking with Me
Urgent-ASAP
When you can schedule a google meet
Reason for Referral
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Relationships with friends/peers
Anger
Worry/Anxiety
Feelings of negativity, discouragement, self-doubt
Study skills, grades and schoolwork
Recent changes in mood, attitude or behavior
Unhealthy or unsafe choices
Perfectionism
A loss (death of person or pet, loss of friend, parent separation or divorce
Planning now for the future
Other (Describe Below)
Comment
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Submit