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 who wants to bring students during school hours, there are appointment times available on Monday, March 2 to Wednesday, March 4. Please contact Fonda, our Cinderella Coordinator, directly at 314-952-8268 to schedule.
2) If you do not need a group appointment, please have the student choose 3 preferred appointment times. The student’s assigned appointment time will be emailed to the student and the student’s counselor or parent.
10:00am - Saturday, February 2911:30pm - Saturday, February 291:00pm - Saturday, February 292:30pm - Saturday, February 294:00pm - Saturday, February 2912:30pm - Sunday, March 12:00pm - Sunday, March 13:30pm - Sunday, March 14:30pm - Monday, March 24:30pm - Tuesday, March 34:30pm - Wednesday, March 4

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 7 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.