COMPREHENSIVE COUNSELOR’S REPORT
Student’s Name: _____________________ D.O.B. _________________ Grade: _____
Previous School Record (include grades, test results, and attendance): _____________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Student’s perception of reason for referral: ___________________________________________
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Summery of counselor’s contacts with student: ________________________________________
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COUNSELOR’S PERCEPTION OF STUDENT
Academically: __________________________________________________________________
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Socially: ______________________________________________________________________
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Intellectually: __________________________________________________________________
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Summery of Findings: ___________________________________________________________
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_____________________________________________________________________________ Counselor’s Signature Date School
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