Referral Form

Counseling Services
REFERRAL FORM

Instructions: Faculty and staff using this form should consider all referrals as confidential. Complete the information requested, if hand delivered place in a sealed envelope and forward to Counseling Services in the Student Development Center, 2^ndFloor – Suite 2260. You may also fax referrals by using the fax number provided on the bottom of this form. Please try to complete this referral form with the student’s assistance. Parents will be notified only with the student’s permission, and/or if the student has any suicidal /homicidal ideations, or if someone has caused them any harm.

Counseling Services Telephone Numbers: Office: 410-651-6449 / Fax: 410-651-7752