Referral Form: School-Based Mental Health Support for Students and Partnership

This form is for school partnerships only! Anchor Counseling & Support Services partners with schools to provide accessible, trauma-informed mental health support for students. School Counselors, social workers, administrators, teachers and other designated school personnel can submit a referral for a student who may benefit from additional support.

If we do not have a partnership, please feel free to fill out the form below. We would love to work with your school district!

Refer a Student

Help a Student Get Connected to Support

Sometimes a student doesn't need to be in crisis to need someone to talk to. They may be struggling with anxiety, emotions, relationships, grief, trauma, behavior, or simply trying to navigate everything happening in their world.

Anchor Counseling & Support Services partners with schools to provide accessible, trauma-informed mental health support for students.

If you are a school counselor, social worker, administrator, teacher, or other designated school professional and believe a student could benefit from additional support, you can submit a referral below.

Who Can Submit a Referral?

School-based referrals may be submitted by:

  • School Counselors

  • School Social Workers

  • Teachers

  • Administrators

  • Student Support Team Members

  • Other Designated School Personnel

Students We Support

Anchor Counseling & Support Services provides support for students experiencing concerns such as:

  • Anxiety and excessive worry

  • Depression or low mood

  • Stress and emotional overwhelm

  • Anger and emotional regulation

  • Trauma-related concerns

  • Grief and loss

  • Bullying

  • Peer and relationship concerns

  • Self-esteem and confidence

  • Coping and problem-solving skills

  • Family-related stress

  • Behavioral concerns

  • School adjustment

  • Communication difficulties

  • Other social, emotional, or behavioral concerns

A mental health diagnosis is not required to make a referral.

What Happens After You Submit a Referral?

1. Submit the Referral

Complete the referral form with the information you currently have about the student.

2. Referral Review

Anchor Counseling & Support Services will review the referral and determine the appropriate next steps based on the student's needs and available school-based services.

3. Consent & Authorization

When required, the appropriate parent/guardian consent, student authorization, and school procedures will be completed before services begin.

4. Student Connection

Once the referral and required permissions are completed, the student will be connected with the appropriate support.

5. School Collaboration

When appropriate and permitted, Anchor Counseling & Support Services will collaborate with designated school personnel to support the student's progress and overall school success.

Ready to Refer a Student?

If you believe a student or your school district could benefit from additional in-person, school-based, mental health support, complete the referral form below.

Important Safety Information

This referral form is not intended for emergency or crisis response and should not be used when a student is experiencing an immediate safety concern.

If a student is in immediate danger or experiencing a mental health or medical emergency, follow your school's established emergency and crisis procedures and contact the appropriate emergency resources.