This information is being obtained to assist school counselling staff in providing support for your child. Provision of this information is voluntary. It will be stored securely. The information collected, and any assessment results, may, as appropriate, be provided to other members of the school staff involved in supporting your child. You may correct any personal information provided at any time by contacting the school counselling staff member.

Please contact the school if you would like help to complete this form.

Parent Referral To School Councellor

Glendale East Public School