Academic Referral Form for Parents
There are many possible reasons why students struggle with the demands of school and begin to fall behind their peers in academics or show behavior problems. In an effort to accommodate the learning needs of those students who experience school difficulties our school uses an approach called Response to Intervention or RTI. RTI is a flexible problem-solving model in which schools provide assistance to match the learner’s needs.

Please complete this form to the best of your knowledge and submit it. RTI Coordinator will communicate with staff and family to collect data and identify any necessary intervention
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Email *
Student's First & Last Name *
Parent/Guardian Name *
Parent phone number
Grade *
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