---
title: English – Student Self Referral Form for Mental Health and Counseling Support
description: "[DCPS-Student-Self-Referral-Form-Mental-Health-SY2324](https://dcpsmentalhealth.org/wp-content/uploads/2023/08/DCPS-Student-Self-Referral-Form-Mental-Health-SY2324.pdf)[Download](https://dcpsmentalhealth.org/wp-content/uploads/2023/08/DCPS-Student-Self-Referral-Form-Mental-Health-SY2324.pdf)"
url: "https://dcpsmentalhealth.org/docs/student-self-referral-form/"
updated: "2023-08-23"
category: Referral Forms
---

# English – Student Self Referral Form for Mental Health and Counseling Support

[DCPS-Student-Self-Referral-Form-Mental-Health-SY2324](https://dcpsmentalhealth.org/wp-content/uploads/2023/08/DCPS-Student-Self-Referral-Form-Mental-Health-SY2324.pdf)[Download](https://dcpsmentalhealth.org/wp-content/uploads/2023/08/DCPS-Student-Self-Referral-Form-Mental-Health-SY2324.pdf)