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SCS Counseling Website


Counselor Forms & Documents

Counselor forms & documents may be downloaded by clicking on the file name in the Form or Document column that corresponds with it's description. Most of the files are Microsoft Word documents and they will be downloaded to your computer when the link is clicked.

Description Form
Weekly chart to assess in- and out-of-class conduct, classwork, and homework. Has bear clip art which makes it appropriate for younger kids. DailyProgReport.doc
Weekly chart by day allows for up to three goals to be rated S (satisfactory), N (needs improvement), or U (unsatisfactory). Place for comments and teacher and parent signatures. SNU goal chart.doc
Weekly chart by subject with space for two goals. Appropriate for older kids. Student success chart.doc
Daily report shows completed areas of academic work, with sentence completion for behavior and rating of day. StudSubj.doc
Weekly chart breaks subjects into lesson and activity with colorful icons. Appropriate for younger children who need smaller time units in behavior plan. Success chart icons.doc
Check on Student
Description Form
Check mark form for student who had academic difficulties in previous year. Acad Concern Student.doc
Check mark form for student retained in previous year. Ret Student.doc
Brief check mark form for teacher to report on student’s mood, self-control, effort, friendships. SpecSpecStud.doc
Counselor Audit
Description Document
Advisory Council Advisory Council.doc
Program Agreement Program Agreement.doc
Program Audit 07-08 Program Audit 07-08.doc
Crisis Referrals
Description Form
A way to document that you have offered Project CLASS services to parents/guardians. Project CLASS referral.doc
A way to document that you have offered SAP to parents/guardians SAP referral.doc
Description Document
List of referred kids, grade, homeroom, referring person, referral date, and concerns. Sized to accommodate computer entry. Caseload-typed.doc
Same as above but larger spaces for those who prefer to write. Caseload-write.doc
Documents conferences between counselor and parents Coun-parent conf.doc
Documents conferences between counselor and teacher. Coun-teacher conf.doc
School counselor’s client contact sheet, sized for computer entry. CounsContactSheet-Type.doc
As above, for writers. CounsContactSheet-Write.doc
Weekly schedule, by day, in half-hour increments Counselor Schedule.doc
Activity log overflow Daily log-addendum.doc
Activity log set up for computer entry Daily log-type.doc
Activity log set up for those who write Daily log-write.doc
Shows attendance, permission slip, evaluations, over eight sessions. Section for comments/kid. Allows list of eight sessions’ topics. GrpCounsRec-2.doc
Shows attendance, permission slip, over eight sessions. Topic, homework, followup by session. Consolidates two forms. Set up for computer entry. GrpRecAllSes-Type.doc
As above, for writers. GrpRecAllSes-Write.doc
An optional form, designates student name, time and date of call, whether message was left, notes. Phone Log.doc
Release of information form modeled after SCS special education department release of information form release of information.doc
First and second semester plan for small groups by grade, topic, and dates. Small Grp Plan.doc
List students, reason for referral, referral source, follow-up, long- and short-term. Set up for computer entry. StudConfRec-Type.doc
As above, for writers. StudConfRec-Write.doc
Form to document anticipated counselor duties throughout the year, by month. This form is set up to type in materials. If you prefer to write, simply delete typing designed to be highlighted and replaced by data entry in each month’s block. Year at a Glance.doc
Envelope Labels
Labels for permission form envelopes that direct parent/guardian/teacher to return to school counselor. Please return to generic.doc
Labels for permission form envelopes that let you designate student, teacher, and Activity (small group name, peer tutoring, etc.) To the parents generic.doc
Feedback to Teacher
Description Form
Follow-up to counseling visit for teacher. Full page, more detail. Feedback for Teacher.doc
Follow-up to counseling visit for teacher. ½ page, less detail. TeachFeedback2.doc
Needs Assessments by Parents
Description Form
List of potential parent meetings. Form to return if interested. Parent Mtg Interest.doc
List of potential student and parent services. Form to return if interested. ParentServicesRequest.doc
Four-point Likert rating scale for multiple items StudNA by Parents.doc
Needs Assessments by Students
Description Form
Student checklist of 12 potential concerns in areas of self, friends, school. Space included for other comments. IndStudNA.doc
Needs assessment for middle school students. MS NA.doc
Ten-item needs assessment for younger students; designed to be read aloud by counselor. StudNA Primary.doc
Students pick top five out of 36 possible concerns. 5th-8th StudNA Top 5.doc
This and “#2” below check into 12 potential concerns with open-ended questions and request for appointment. Some overlap. This one has question assesses careers; #2 checks out more personal/social/emotional realms. Appropriate for use with 3rd- – 6th-grade students. StudNA3-6#1.doc
See above. StudNA3-6#2.doc
Nine potential concerns, with open-ended “Other:” Can request appt. StudNeeds-list.doc
Students check off any concerns from list of 14. Can request appt. Use with grades 4-6. StudNeeds4-6.doc
Key to use with worksheet, below. Key StudNPic1-3.doc
Yes/No format worksheet taps eight needs areas. Use with grades 1-3. StudNeedsPic1-3.pdf
Needs Assessments by Teachers
Teacher needs assessment for classroom guidance. CG NA by Teach
Four-point Likert rating scale for multiple items StudNA by Teachers.doc
Teacher input regarding importance of various counselor functions. TeachNA RoleCounProg.doc
Permission Forms
Description Form
Permission form for Anger Management Small Group AngMgtSmGrp.doc
Permission form for Divorce Small Group DivSmGrp.doc
Permission form for Individual Counseling IndCounsePerm.doc
Permission form for Study Skills Small Group StudySkillsSmGrp.doc
Program/Activity Evaluations by Parents
Parent evaluation of your work with their child in individual counseling Ind Couns Parent Eval.doc
Parent evaluation of program with yes/no and open-ended questions Parent Eval Couns Prog.doc
Another variation of parent program evaluation; yes/no with opportunity for comments Parent prog eval.docc
Parent evaluation of child’s small group experience Small Groups Parent Eval.doc
Program/Activity Evaluations by Students
Student evaluates individual counseling experience Ind Couns Stud Eval.doc
Student evaluates small group counseling experience Sm Grp Stud Eval.doc
Students evaluate an activity. Use for small groups or class. 3rd-grade and up. StudActivityEval.doc
Student evaluation of counselor, 3rd-5th grade level. StudCounsEval 3-5.doc
Student evaluation of counselor, 6th-8th grade level. StudCounsEval 6-8.doc
Student evaluation of counselor, K-2nd grade level. StudCounsEval K-2.doc
Students evaluate lesson. Scaling. Maybe 3rd, 4th and up. StudLessonEval.doc
Counselor/program awareness and evaluation. StudProg Eval 5-8.doc
Program/Activity Evaluations by Teachers
Teacher evaluation of your work with their student in individual counseling Ind Couns Teacher Eval.doc
Teacher evaluation of student’s small group experience Sm Grp Eval Teach.doc
Likert-scale teacher evaluation of program at year’s end Teach Prog Eval.doc
Same as above though administered at mid-year TeachMid-yrEval.doc
Referral to Counselor
Description Form
Very basic. Teacher checks personal, school, or academic with room for additional comments Couns Ref Basic.doc
Teacher request for counselor to provide specific services. Includes section to return to teacher with feedback. CounsRef.doc
Detailed overview of issues DetailedCounsRef.doc
Another version of the same. SchCounsRefForm.doc
Another counselor referral form. Describes problem, attempted interventions, teacher’s suggestions. Teach Refer to Couns.doc

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