Counsellor Referral — NAGLE CATHOLIC COLLEGE

The Counsellors' offices are located in the Presentation Centre, on the Ground Floor in the Convent Building. You may make an appointment in person or use the form below.

Please contact the Presentation Centre reception if you do not hear from a Counsellor within 48 hours.
If you or someone you know is at immediate risk, please present to the PC immediately or if it is after school hours please contact 000, Lifeline 131114 or Kids Helpline 1800 55 1800.

Name *

First Name

Last Name

Homeroom *

(###)

###

####

Year Group *

How would you like to be contacted by the Counsellors *

Note via Home Room

Request for *

College Counsellor

Referral to External Services

Urgency *

Urgent 24-48 hours (critical incident; harm to self or other students/disclosure/significant crisis)

Within 1 week (feeling distressed/upset, reached crisis point/urgently need support)

Within 2 weeks (not crisis but would like support as soon as possible)

Personal reasons (tick all that apply)

Family/Home

Anxiety

Self-Esteem

Bullying

Grief/Loss

Self-Harm

Peers

Abuse

Relationships

Depression

Anger

Other

Education Reasons (tick all that apply)

Time Managment

Study Skills

Stress Management

Are you parents aware of this referral?

Yes

Thank you!

Nagle Catholic College
101-103 Sanford Street Geraldton, WA 6530
PO Box 97, Geraldton, WA 6531
Ph: (08) 9920 0500