Tier II Intervention Referral
Referral Sender's name
Referral Sender's Phone # (optional)
Referral Sender's relationship to the student
Student ID # (if known)
Interventions offered at AHS:
What intervention does this student need?
Check In, Check out (CICO) - a mentoring program that supports student by monitoring daily attendance, classroom performance, and behavior.
Wellness class A - develops skills to help manage anger, aggressive impulses, and conflict
Wellness class B - develops skills to help manage substance abuse issues
Wellness Class C - develops skills to address truancy issues in school
Life Skills - develops skills in socializing, bully intervention, substance abuse, healthy choices, conflict resolution and mediation, and counseling
Academic Tutoring - available after school on select days to be determined
Counseling for Academics
Counseling for Social Emotional Support
Why does this student need this intervention?
Thank you for submitting a referral to support an AHS student! A member of our intervention team will contact the student within 3 days.
AHS, we are the SAINTS who Achieve, Honor, and Serve!
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This form was created inside of Victor Valley Union High School District.