Center Grove School 25 Schoolhouse Road

Randolph, New Jersey 07869 973-361-7835

 “We commit to inspiring and empowering all students in Randolph schools to reach their full potential

as unique, responsible and educated members of a global society.” Mr. Mario Rodas Ms. Michelle Telischak Principal Vice Principal 

Individual Counseling Permission Form Mrs. Sullivan, the school counselor, conducts short term individual counseling sessions with students on an as

needed basis. You child has been recommended for this service. Please indicate below if you give your consent

for your child to participate. Efforts will be made to avoid having your child miss instructional time.

_____________________________has permission to participate in individual counseling sessions with Mrs.

Sullivan, School Counselor.

_________________________________ _____________________________ Parent/Guardian Signature Date

Additional information: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________