Faculty Referral for Student Counseling Teacher/ Staff Referral Teacher or Staff-submitted Student Referral for counseling services through Catholic Charities HiddenNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.Student Name(Required) First Last Grade Level(Required)7th8th9th10th11th12thHomeroom Teacher Best time to meet with student (if known) What area(s) are you concerned with for this student?Personal/Social Peer Relationships Emotional issues Friend/Family dynamics Other (please describe below) Academic Grades Attendance Homework Other (please describe below) Behavioral Concentration Fighting/Bullying Withdrawn Other (please describe below) Have any other interventions been attempted? Please provide any additional information that could be valuable to the situation. Δ