Dalton CARE Team Student Referral for 2021/22

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Thank you for taking the time to make this referral.

District *

Dalton Local

Required

Building *

Dalton HS

Dalton MS

Dalton ES

Required

Student First Name *

Student Last Name *

Grade *

Reasons for Referral *

Please check all relevant boxes that describe your concerns for your student

Academic

Attendance

Behavior Referred to Office

CPS

Death of Parent or Caregiver

Family Support Needed

Gender Identity/ LGBTQ

Homeless

Incarcerated Parent or Caregiver

Medical

Raised by Single Parent or Grandparent

Social or Emotional

Substance Use

Additional Student Information

Student Referred To CARE Team *

Required

Gender *

Ethnicity *

Race *

Student Age *

Zip Code *

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