Counsellor Referral

Thank You

the form has been submitted

Counselling Referral

Students Name

Year Level

Date of Referral



If 'Other' please specify here

Issues of Concern

If 'Other' please specify here

Brief Outline of the Concern - Including any safety issue

Have you spoken to Year level Coordinators about this student?


Priority of the referral


We Give Thanks...

“St Teresa's College would like to acknowledge the Warrgamay People, the traditional owners of this country, who freely lived and hunted here as recently as the 1940's. We acknowledge the hospitality of the Warrgamay People, the hospitality of this land, and the reciprocal relationship the College enjoys with their current generations."

Oct 21

We are in Week 3, Term 4
There are 9 weeks in Term 4