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boarding handbook 2026 27printed 32 · PDF 32
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Boarding Handbook
Academic Year 2026-2027
Annexe 3: Referral to the Psychologist Form
Student's Name: __________________________
House: __________________________________
Class & Section: __________________________
Date of Referral: __________________________
Source of referral: ________________________
Confidentiality and Consent
Parent/Guardian Consent Obtained: Yes/ No
Date: _________________________
Via: Phone/Email/Letter
By: _________________
Name of Parent: __________________________________
Signature of Parent/Guardian: _______________________
Note: Aitchison College has the right to send the student to the psychologist for his benefit in severe/ urgent
instances if the college is unable to reach the parents via telephone/ email.
Reason for Referral
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Date (First seen by the psychologist): _____________________________________________
Psychologist Remarks:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Referred for Psychological Assessment Outside the School
☐ Yes ☐ No
If Yes, List psychological tests and recommended centres:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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