Carthage Junior High Counselor Referral
Please complete this form in order to connect with a counselor at CJH. A staff member will follow up with you. Thank you!
Name of person completing this form
*
First Name
Last Name
Are you a staff member, parent/guardian, student, or other?
*
Staff Member
Parent/Guardian
Student
Other
Student's Name
*
First Name
Last Name
Student's Grade Level
*
Please Select
7th Grade
8th Grade
DAEP
RISE
Please choose one (or more) reasons for the request:
*
Academic
Behavior
Social
Mental Health (sad, angry, anxious/worried, depressed, grief, etc.)
Other
Submit
Should be Empty: