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Student Referral Form

Student Referral Form


This referral form is for use by Roseville Adult School students who are in need of support from a school counselor for themselves or a person they are concerned about.
 
PLEASE NOTE: If you or someone you know is in a LIFE-THREATENING SITUATION or experiencing a mental health crisis or emergency, please stop completing this form and CALL 911 IMMEDIATELY.

You can also find 24 hour help at the 988 Suicide & Crisis Lifeline (988lifeline.org) -- dial or text 988 for support now.