Student Counseling Summary Report Form
Document and summarize details of student counseling sessions for accurate record-keeping and follow-up.
Student Name
*
First Name
Last Name
Student ID Number
*
Counselor Name
*
First Name
Last Name
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Session Type
*
Individual
Group
Family
Other
Presenting Issue(s)
*
Academic Concerns
Behavioral Issues
Emotional Well-being
Social Relationships
Family Issues
Career Guidance
Other
Interventions/Strategies Used
*
Active Listening
Goal Setting
Problem Solving
Referral to Other Services
Parental Involvement
Coping Skills Training
Other
Student's Response/Participation
*
Engaged
Partially Engaged
Resistant
Other
Session Outcome
*
Resolved
Ongoing
Referred
Other
Follow-up Actions/Recommendations
Additional Notes (optional)
Submit Report
Should be Empty: