This form is for Teacher's only to complete. Teachers will need to login with your Knox County Schools email and AD password. 

This form is for staff members to request counseling services. Any information shared in this form is for the use of the school counselor and will NOT be kept in the any cumulative files. If the basis for your referral is to report any abuse, neglect, or intent to harm, you are required to contact the Department of Children's Services at 877-237-0004.  Thank you for helping me better serve our students.