BCHS student services referral form
What is the first and last name of the person you are referring?
What grade is this student currently enrolled in?
Who is making the referral?
What is the reason for the referral? What is your greatest concern?
How would you like your concern prioritized?
Urgent-student is a risk to him/herself or others or is being harmed.-Needs to be seen today!
HIgh Priority-Needs to be seen within the next day or two
Medium Priority-Needs to be seen withing the next week.
Low Priority-Needs to be seen iwithn the next couple of weeks.
Please check who you would prefer to help with this concern?
Mrs. Charlene Assenheimer (Associate Principal/Student Services)
Mrs. Trudy Gammel (Family School Liaison)
Mrs. Karen Ladan (Counsellor)
Mr. Prakash Raju (High School Completion Advisor)
Miss Margryt Rispens (Counsellor)
Mr. Ed Tobin (Academic Support)
Ms. Susan Wegner (Career Counsellor)
Optional: What is your name and/or how shall we contact you if we have questions regarding this referral?
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This form was created inside of Pembina Hills Regional Division # 7.
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