Referral to
Student Life Counselor

Instructions: To make a referral to the Student Life Counselor:

• Open the attached Referral Form that is in Word format or a Referral Form in PDF format..
• Print the form and fill in the requested information completely.
• Send the original of the form to the Student Life Counselor in a sealed envelope.
• Keep a copy for your records. Provide the student with a copy of the resource page.
• Advise student to attempt to contact the Student Life Counselor as soon as possible.
• Inform the student that the Student Life Counselor will use the information provided to attempt to make contact.

CRISIS SITUATIONS: In situations in which a student is threatening harm to self or others, it is NOT sufficient to provide a referral. In this case, one of the resources listed below must be contacted immediately.  For telephone numbers of Mental Health Resources for Cowley College Students, go to Resources and Contact Information.