Self-Referral Forms For School Social Workers And School Counselors

- Grades
- Not Grade Specific
- File type
- Preparation
- Print ready
- Subject
- Social Emotional Learning (SEL), Special Resources
- Topic
- Referral Forms, School Counselors
- Preparation
- Print ready
From the author
About this resource
This Self-Referral Counseling Slips are the best resource to have as a school counselor! This resource allows students to reserve a time to speak with you when they feel as though they need it.
These referral counseling slips is a great back to school counseling resource that can be easily implemented. Simply print a bulk of forms and pass them out to teachers at the beginning of the year. They can placed in classrooms so when students feel as though they want to meet with the counselor, they easily can!
Benefits of Self Referral Counseling Slips:
Allows you to track all kids that you see
Helps with case notes at the end of the day
Helps to establish a baseline of needs that students might have
Can be used to implement push-in curriculum as a tier 1 support (if you see a lot of friendship related referrals, you know that this might be a need).
Helps to better manage your schedule while still maintaining flexibility
Helps to identify students who might need individual extra SEL support
When utilizing this activity, students will be able to advocate for themselves when they feel as though something is wrong, begin to identify when they need outside support, and form relationships with trusted adults!
Ideas For Use in Implementation:
⭐ Back To School Resource Packets
⭐ Open Houses
⭐ Meet the Teacher Nights
⭐ Push-In Lessons for tier 1 support
In the classroom
Teaching tips & learning objectives
Teaching tips
Give teachers stacks of the referral slips to keep on hand in their own classrooms through the year
Reserve the hall passes for students who tend to keep concerns to themselves or find it hard to say out loud that they need to talk
Photocopy each page before cutting it apart, since a single page holds two identical referral slips or six identical hall passes
Skills covered
Self-advocacy — a student identifies a topic (family, friends, school, other kids, their own actions, or feelings) and rates how big the problem feels before requesting help.
Help-seeking initiation — a hall pass lets a student signal they need a private conversation without asking out loud in front of classmates.
Good to know
Questions teachers ask about this resource
What does a student fill in before handing in a chat slip?
Their name, the date, and their teacher, plus one topic checkbox (family, friends, school, other kids, their own actions, or feelings) and a rating for the size of the problem.
Do the two hall-pass designs ask for different information?
No — both use the same layout; only the heading changes, between I Need To See The Social Worker and I Need To See The Counselor, so the wording can match whichever staff member a student is sent to see.
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Resource details
Concepts & topics
Core concepts
Self-referral
Hall pass
Social-emotional check-in
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