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.