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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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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Counselor Name
*
Your answer
Which of the following could be identified as the student need (mark all that apply)?
*
The student is returning to school after dropping out
The student is returning from a treatment or residential facility
The student is a parent or expecting
The student is critically behind in credits and not on track to graduate with their cohort
The student needs a different approach to learning (smaller classes sizes, fewer classes at a time, etc.)
Other:
Required
SVHS staff have had a conversation with this student's parent/guardian about transferring to SCHS?
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Yes
No
Academic Functioning (Please rate the student)
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Lowest
1
2
3
4
5
Highest
Comments regarding academic functioning:
Your answer
Social Skills
*
Lowest
1
2
3
4
5
Highest
Comments regarding social skills:
Your answer
Maturity
*
Lowest
1
2
3
4
5
Highest
Comments regarding maturity:
Your answer
Family Situation
*
Lowest
1
2
3
4
5
Highest
Comments regarding family situation:
Your answer
Does the student currently receive any of the following services?
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IEP
504 Plan
ELL
Gifted/Talented
None
Other
Are there any safety concerns/considerations that we should know about including threat or lethality assessments, child abuse reports, behavior plans, etc.?
*
Yes
No
If yes, briefly describe. Please also include the best person to contact on your staff to receive further information.
Your answer
Has the student had attendance issues?
*
Yes
No
Has the student had behavior issues?
*
Yes
No
If yes to attendance or behavior issues, please explain.
Your answer
Thank you! If you have any additional information please provide it below.
Your answer
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