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Bilay National High School

GUIDANCE CENTER AND TESTING OFFICE (GCTO)

COUNSELING FORM
Date:
Name of Student:

Year & Section:


Contact No.:
Nature of visit (please check): [ ] Walk-in [ ] Referral:______________________
Problem(s)/ Concern(s)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Action Taken/ Recommendation(s):


_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Follow up:
Date(s):___________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

_______________________________ _____________________________
Counselee Guidance Counselor

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Counseling Slip

Name of Student: Date:


Grade & Section:
Session ended:

___________________________________________
Guidance Counselor

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