Student Support Referral Form
If you have concerns about a student’s social skills, emotional well-being, attendance, or behavior, you can use this form to connect them with school social work support.
Who can fill it out?
This form can be completed by:
~Teachers and school staff
~Parents and guardians
~Outside professionals, such as therapists, case managers, or social workers
When should it be used?
Submit a referral any time you notice a student might benefit from additional support—whether that’s help with friendships, coping skills, attendance, family changes, or other personal challenges.
What to include:
~Student’s name, grade, and your contact information
~A brief description of your concern(s)
~Any previous support or interventions
~If the student is currently working with other professionals (inside or outside of school), please share their name(s) and contact information
Confidentiality:
All information provided will be kept private and used only to help connect the student with the support they need.
What happens next:
Once your form is submitted, I will review it and follow up with you within a few school days to discuss next steps.