Cinderella Project High School Counselor Referral Form

Student Name (Required)

Name of High School (Required)

Student Cell Phone

Email Address Student Checks Regularly (Required)

Counselor Name (Required)

Counselor Phone Number (Required)

Counselor Email Address (Required)

Parent Name (Required)

Parent Phone Number (Required)

Parent Email Address (Required)

Grade (must be 11th or 12th - student must show student ID to prove age) (Required)

Date of Prom

Estimated Dress Size (Required)

Appointment Time (Required)
1) If you are a school counselor or case manager who wants to bring students during school hours, there are appointment times available on Monday 2/25 through Wednesday 2/27. Please contact Fonda, our Cinderella Coordinator, directly at 314-952-8268 to schedule.
2) If the student will come after school or in the evening to choose her gown, please have the student choose 3 preferred times. An email with assigned appointment time will be sent to the student and the counselor.
10:30am - Saturday, February 2312:00pm - Saturday, February 231:30pm - Saturday, February 233:00pm - Saturday, February 2312:30pm - Sunday, February 242:00pm - Sunday, February 243:30pm - Sunday, February 244:30pm - Monday, February 254:30pm - Tuesday, February 264:30pm - Wednesday, February 27

We understand that your school may have additional low-income girls who need help to have the prom of their dreams. Starting on Saturday March 3 at 10:00am, all remaining dresses at the Cinderella Boutique in ReFresh will be available to the public for $35 or less.

For more information, contact Fonda Richards at 314-952-8268.