Turn “something feels off” into clear, objective documentation a school counselor can act on.

This 7-page fillable PDF toolkit helps teachers and student-support teams notice warning signs, document observable patterns, choose the appropriate next step, submit a useful counselor referral, and follow up after the referral.

What’s included

Warning Signs Checklist: Academic, behavioral/emotional, and attendance concerns organized by support level.
From Judgment to Observation: Replace vague impressions with specific, objective language.
Observation Log: Track patterns over time instead of relying on memory.
Support, Refer, or Emergency? Decision Guide: Choose the appropriate response.
Student Concern & Referral Form: Fillable student information, concern categories, urgency scale, and documentation prompts.
Follow-Up & Communication Log: Close the loop and monitor changes.

Perfect for

Middle and high school teachers
School counselors and student-support teams
Grades 6–12
MTSS, RTI, Tier 1, and early-intervention documentation
Teacher-to-counselor referrals
Staff professional learning

Product details

7-page digital PDF
77 genuine fillable fields
Type directly into the forms or print and write
US Letter size
Instant digital download; no physical product will be mailed

Created by a former high school counselor with 15 years of experience supporting students.

Important: This resource is educational and organizational. It does not provide legal, clinical, or medical advice and does not replace mandated-reporter training, district policy, crisis procedures, or emergency protocols.

Related guidance: See how Guidance Game Plan develops practical school resources.

teacher forms

Classroom Concern & Counselor Referral Toolkit | Fillable PDF