Confidential Counseling Referral Form

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Confidential Counseling Referral Form


  1. Complete Student of Concern Referral Form below.
  2. Referring faculty or staff will be notified when referral form has been received.
  3. In order to maintain confidentiality, the Student Wellness Center may need to limit or keep private information discussed after the referral is processed.

Call Public Safety Officer (661) 763-7872  or 911 for incidents that warrant immediate attention (e.g. fights, loud arguments, threats, and crimes in progress).

Thank you for taking the time to bring the needs of this student to our attention