Manhattanville College Counseling Center
Pamela P. Duncan, PhD, Director
914-323 5158

Counseling Center Referral Form*

*To be used by faculty and administrative staff only!

Please complete this form when referring a student for counseling or assessment. It will be e-mailed to Pamela Duncan upon submission.

Please provide the following information about the student:

First Name
Last Name
Phone
E-mail

Reason for Referral:

Referred By:

First Name
Last Name
Title
Phone
E-mail


Revised: March 26, 2009