Counseling Services Department Referral Form

To make a referral:

• Call Counseling Services (ext. 2752) or bring the student to room 10-324. For immediate attention of nonviolent situations or crisis, call the Crisis Counseling Hotline at 851-6694(pager).

• Convey verbally, Fax (ext. 5118), send interoffice mail or bring a referral form or note to identify the following critical information:
  • Name of student
  • Name of referring individual
  • Reason for referral—in objective, behavioral terms
  • Specific actions or steps that the counselor and/or student needs to take for follow up to the referral.