STUDENT SUPPORT & RESOURCES

Counseling Service Department Referral Form

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.

Today’s Date:                                              

Time:

Student’s Name:      

Student’s SSN or ID # 

Reason for referral:

Actions or Steps for follow up to the referral:

Referred to:

Department of Counseling Services

Room 10324 Phone: 512-2752

Referred by: Phone Ext.

           

 



Did You Know?
Nine of our students have made the Academic All-American First Team for Community, Technical and Junior Colleges—more than at any other community college.
Sinclair is one of only 12 Vanguard Learning Colleges in the U.S. and Canada, named for our "outstanding record of achievement in learning-centered education."
Sinclair is the largest regional provider of online education, with more than 180 different online courses.
Sinclair has established more than 100 transfer agreements to assist students in transferring to other colleges.

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