[Counseling Service Referral Form]

Instructions:

To make the text bigger press CTRL + in windows and CMD + (plus) in mac.
Fill up as many fields as completely and accurately (copy & paste preferred over typing) as possible before sending the form to the next person/office who will fill up other fields or approve/sign.
Carefully read everything before you sign. It will be in the history of the form.
Only sign where you are supposed to sign. Signing where you not supposed to sign may cause the receiving office not to honor the form due to incorrect data. You will have to initiate a new form.
Feel free to require a no-erasures form.
Editing entries after having been signed will cause signature to alarm and need re-signing.
When all required signatures are completed the form becomes locked.
If there is a mistake in the data/signatures, instantiating a new clean form is a good idea.
Tutorial

hopefully this:

is easier than printing, signing, scanning and sending
is safer than walking around asking people to sign during pandemic
is less worrisome than sending around electronic photos of signature
fills up the gap of google form for not having signatures
enables the creation of online forms faster than development of systems for each form

Counseling Service Referral Form

user: Login with AOLIS employee account for college enrollment | Login with AOLIS Student Account | Login with @aup.edu.ph AUP Email account | | time: Fri May 3 03:35:20 PST 2024 , forminstanceid: 0 Last signed: . Last edited: . | Signatures/Approvals: 0/0

Name of Client to be Referred

Program / Year Level

Referred by

Today's Date

Reason/s for the Referral - Problems / Concerns Related:

Frequent Absenteeism: The students incurred 3 to 4 absences in certain courses.

Course

Teacher

Frequent Tardiness. The student is observed to be habitually late.

Sanction from Behavioral Management Office / SSO: These are sanctions or disciplinary actions issued by the Behavioral Management Office or Student Services Office.

Document Attachment

Poor cognition. The student shows difficulty understanding even simple instructions; is inattentive, or has bizarre thoughts

Displaying Abrasive or Aggressive Behavior: The student exhibits conduct that is harsh, forceful, or confrontational, often characterized by a lack of tact, sensitivity, or consideration for others. This behavior may involve using harsh language, being overly critical, or expressing hostility towards others.

Noticeable Changes in Personal Hygiene: The student declined practicing hygiene such as bathing, tooth brushing, hair care, or overall cleanliness.

Loss of Appetite and Sleep Difficulties: The student expressed or appeared as if having loss of appetite and difficulty of sleep.

Suicidal Attempts: A student exhibits behavior indicating self-harm or reveals plans to end their life.

Expressed feeling depressed or anxious: Student has expressed having problems with his or her mental health

Misconduct: The student is uncooperative, disrespectful, and defiant.

Others (Specify): Include any additional observable behaviors not covered by the above categories, specifying the nature of these behaviors.

Counselor’s feedback/Action Taken

Send to guidance@aup.edu.ph

| Save first before Send | | |

History

date_time	user	info	info