Counselor
Recommendation

Teacher Name:  ____________________________

Date:  _______________

Student:  _________________________________

This student is currently deficient in the following area(s):

Grades _____  Attendance _____  Discipline _____  Other _____

Please contact me as soon as possible concerning options available in order to correct the current situation.  I would like to schedule a meeting with you, the student, and possibly a parent concerning this issue.

Please indicate the time and day most convenient for this conference.
 

Day Monday Tuesday Wednesday Thursday Friday

Time

I would appreciate your prompt attention.
 

Counselor Signature:  _______________________________

Date:  ____________