Counseling Service Self-Referral Form

Kinnikinnick C.C.S.D. #131

"Reaching for New Heights"

Home
District
Schools
Kinnikinnick Kids Care
1:1 Technology Initiative Website
Academic Information
2019-2020 Supply Lists
Preschool and Kindergarten Screenings
Parent and Student Handbook
General Information
District Calendars
Power School Parent Portal
Roscoe PTO
Employment Opportunities
Accelerated Reader
DIGITAL BACKPACK
K-12 Payment Center (Electronic Payments)
2019-2020 Registration
Registration Fees
Summer School Registration

Roscoe Middle School
Counseling Service Self-Referral Form

* Indicates required field

Name *

First

Last

Date *

Please provide a brief description of the concern you would like to discuss or problem solve: *

**If this is a crisis (abuse, neglect, threat of harm to self or others), please contact Mrs. Dean immediately. If she is not available, please contact Mrs. Cropp or Mr. Kaufman so we can ensure the safety of all students. The number is 815.623.2837.

Submit

Roscoe Middle SchoolCounseling Service Self-Referral Form

Roscoe Middle School
Counseling Service Self-Referral Form