Is the student exhibiting the need to speak to a counselor? Please fill form located to the left to submit a referral to the counselor.
If you have concerns about a student and feel that they may benefit from extra support please fill out the form.
PLEASE NOTE: IF THE STUDENT IS EXBITING SIGNS OR HAS EXPRESSED DESIRES OF SELF-HARM OR SUICIDE, CALL THE FRONT OFFICE FIRST, THEN COMPLETE THE REFERRAL.
CPS Referral Form BLANK.pdfMake sure to download/make a copy of the form and fill out the form.
As mandated reporters it is our responsibility to report child abuse to CPS. I am attaching the CPS form which needs to be filled out whenever a CPS report is done. Several teachers have asked if there is a procedure for reporting a situation to CPS. Please feel free to take the CPS form that is attached and save it into your files in case you ever need to submit a CPS report.
The procedure I follow:
Open form and completely fill out all sections of form with information.
You may type up a document in Microsoft Word and attach it if there is not enough space for incident information.
Call one of the following numbers to report the situation.
1-800-442-4918
1-877-922-4453
Fax 1-951-413-5122
Make sure that you get the name of the person you are giving the information to and put that name, position, and the time you called onto the top of the form where it is needed in Section B.
CPS requires that the form be faxed to their office using the above fax number. That way they are getting the information orally over the phone but are also getting the faxed form with your signature.
Let me know if you have any questions.
Try multiple interventions
Each intervention should be tried for a minimum of 4 weeks, & more than 1 intervention may be implemented at the same time
Collect and track specific data on each intervention tried & its effect
If your data indicates no progress after a minimum of 6 months, you may consider moving to tier 2 interventions
