: 619-562-7329 School: Date:_________ Person Completing Form (circle one): Parent Guardian ES Other: _______________ ES #: Student # : ES Name: Student name: Date of Birth: ________________ Age: _________ Grade: _________ Sex: M / F Parent #: Parents Name: Parents Address: Parents Phone: Email: Purpose Of Referral (Check all that apply) ___ Curriculum help ___ Health issues ___ Learning difficulties ___ Social/emotional problems ___ Appropriateness of school placement Other: ___________.
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How to fill out the Golden Valley Charter School Student Study Team Referral Form online
Filling out the Golden Valley Charter School Student Study Team Referral Form online can be a straightforward process when you understand the components of the form. This guide will help you navigate each section and provide detailed instructions to ensure that your referral is accurately submitted.
Follow the steps to accurately complete your referral form.
- Click the ‘Get Form’ button to access the document and open it in your preferred online editor.
- Begin by filling in the school name and date in the designated fields to identify the referral context.
- Indicate the person completing the form by circling the appropriate role: Parent, Guardian, ES (Educational Staff), or Other. Provide the ES number and student number as required.
- Enter the names of the educational staff (ES name) and student name to ensure the form is correctly addressed.
- Fill in the date of birth, age, grade, and sex of the student. Use the designated options for sex: M or F.
- Provide the parent's contact details, including their name, address, phone number, and email address, to facilitate communication.
- Specify the purpose of the referral by checking all applicable points, such as curriculum help, health issues, learning difficulties, or social/emotional problems. Include any other reasons in the space provided.
- Detail the school history by listing all schools attended, including dates, and note any significant disciplinary actions such as retention, suspension, or expulsion.
- Indicate whether the child has ever been enrolled in a special education program. If yes, provide an explanation in the space given.
- List the student's strengths and concerns in the corresponding sections to give a comprehensive overview of the student’s profile.
- Describe any methods that have been attempted to address concerns, along with the resulting outcomes, to inform the Student Study Team of previous interventions.
- Provide any additional information that may be relevant for assessment or support.
- Sign the form to request a meeting with the Student Study Team. Ensure you include the date of the signature.
- After completing all fields, save changes, and consider downloading, printing, or sharing the form as necessary for submission.
Complete the Golden Valley Charter School Student Study Team Referral Form online today to initiate support for the student.
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