COUNSELING PERMISSION FORM by vef11fF0

VIEWS: 2 PAGES: 1

									                  COUNSELING PERMISSION FORM

The elementary school counselor, Mrs. Dunn, has permission to provide individual and/or
group counseling services to my child. I understand that the counselor may communicate
educationally relevant information to other professional school personnel directly involved
with my child and/or with his/her education.

The purpose of the counseling services is to address:

_______     School Performance

_______     Adult/ Peer Social Interaction

_______     Personal Behaviors

_______     Situational Concerns

_______     Other ____________________________________________________

If you have any questions, please contact Mrs. Dunn at 682-867-6600.

__________________________________________              __________________________
Student’s Name                                          Grade/ Teacher

__________________________________________              __________________________
Parent Signature                                        Date

__________________________________________              __________________________
Home/ Work Phone                                        Email Address

								
To top