San Sebastian Cathedral School of Tarlac, Inc.

F. Tañedo St., Brgy. Poblacion, Tarlac City

S.Y. 2021 – 2022

School Counselor Referral Form

Today’s Date: October 25, 2021

Student’s Name: Ashleigh Chryztein R. Protacio

Grade and Section: VI - Justice
Best time to see: 1:00 PM (After Online Class)
Teacher: Mr. Gerald D. Vasquez

Reason for referral:

She needs to be counseled because of her misconduct during her EPP Class. (She
was caught playing with the knife in her hands like she was apparently injuring
herself.)

Parent contacted about referral. Date: October 26, 2021 Time: 1:00 PM