Counselor Recommendation Form
Please answer the following questions to the best of your knowledge.  Your answers will be kept confidential and will not be shared with the student or parents.
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Student Last Name *
Student First Name *
Counselor Name *
Which of the following could be identified as the student need (mark all that apply)? *
SVHS staff have had a conversation with this student's parent/guardian about transferring to SCHS? *
Academic Functioning (Please rate the student) *
Comments regarding academic functioning:
Social Skills *
Comments regarding social skills:
Maturity *
Comments regarding maturity:
Family Situation *
Comments regarding family situation:
Does the student currently receive any of the following services? *
Are there any safety concerns/considerations that we should know about including threat or lethality assessments, child abuse reports, behavior plans, etc.? *
If yes, briefly describe.  Please also include the best person to contact on your staff to receive further information.
Has the student had attendance issues? *
Has the student had behavior issues? *
If yes to attendance or behavior issues, please explain.
Thank you!  If you have any additional information please provide it below.
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This form was created inside of Lincoln County School District #2. Report Abuse