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Parent Counseling Referral From
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Parent Counseling Referral From
Parent Portal
Parent Referral Form for Counseling Services
Parent Name/Nombre del padre
Parent Email / Correo electronico del padre-madre
Your Child's Name / El Nombre de su Hijo/a
Grade / Curso
Academic Reason for Counseling Referral / Razón académica para la recomendación de consejería
Attendance / Asistencia
Underachievement / Bajo rendimiento
Study Skills / Habilidades de estudio
Organization / Organización
Homework / Tarea
Tardiness / Tardanza
Difficulties with learning / Dificultades en el aprendizaje
Difficulties with speaking / Dificultades en el habla
Difficulties with language / Dificultades con el idioma
Other
Social/Emotional Reason for Counseling Referral / Razón social / emocional para el referimiento
Anger Management / Control de la Ira
Social Skills/Friends / Habilidades Sociales/Amistad
Negative Attitude / Actitud Negativa
Withdrawn/Shy / Retirado/Tímido
Confidence/Self-Esteem / Confianza/Autoestima
Anxiety / Ansiedad
Uncooperative/Defiant / No cooperativo/Desafiante
Adjustment / Adaptación
Grief / Dolor
Personal Hygiene / Higiene Personal
TCK / Niños de Tercera Cultura
Emotional Liability / Labilidad Emocional
Depression / Depresión
Self harm / Conducta autolesiva
Lack of motivation / Falta de motivación
Nervous tic / Tic Nervioso
Adjustment (is not adapting to school environment)/ Adaptación (no se ha adaptado al entorno escolar
Abuse / Abuso
Family Conflict / Conflicto Familiar
Affected by Divorce / Atravesando dificultades causadas por divorcio en la familia
Other
Behavioral Reason for Counseling Referral / Razón conductual para el referimiento
Not paying attention / No presta atención
Impulsive behavior / Impulsividad
Disrespect to authority - Defiant / Falta de respeto hacia la autoridad - Desafiante
Aggressive behavior (hitting, slapping, name calling) / Comportamiento agresivo (golear/humiliar)
Concerns in early development / Dificultades en el desarrollo
Problems in family dynamic / Problemas en la dinamica familiar
Early sexual activity / Actividad sexual temprana
Other
Is your child attending therapy? / ¿Actualmente está asistiendo una intervención psicológica?
Yes
No
How can the school help? / ¿Cómo podemos apoyar desde el colegio?
Student needs to talk with a counselor... / El estudiante necesita hablar con psicología...
Right away! / ¡Inmediatamente!
Sometime today / En algún momento hoy
Sometime this week / En algún momento de esta semana
I would like you to talk with him/her... / Me gustaría que hablaras con él / ella ...
One time / Una vez
Several individual sessions / Varias sesiones individuales
Other
Incluya todo lo que pueda ser útil para mí sobre la situación.
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Parent Portal