2022-2023 PACE High School Student Referral
Mat-Su Borough School District
1775 W. Parks Highway; Wasilla, AK 99654
Phone: (907) 864-2671
Fax: (907) 373-1436
Lebron.McPhail@matsuk12.us

Special Instructions:  Please complete this referral form prior to a student applying to the PACE program.  

*Administration:  Please send Mr. Lebron McPhail a copy of the suspension letter, threat assessment, and/or behavioral conference, if applicable.  Additionally, please provide grades from courses the student is currently enrolled and indicate if the student is on track with credits to graduate. 

Also, please be sure to collect any of your school's items from the student prior to referring them to PACE. (These items may include chromebooks, textbooks, calculators, uniforms, and library books.)

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Email *
Student Name *
Grade *
Student ID Number *
Student Date of Birth *
MM
/
DD
/
YYYY
Referring School *
Student's Physical Address: *
Student's Mailing Address: *
Student's Cell Phone #: *
Student's Home Phone #: *
Parent's Name: *
Parent's E-mail Address: *
Parent's Cell Phone Number *
Parent's Home Phone #: *
Reason for Referral: *
Does the student have a Current 504 or IEP (Individualized Education Plan)?
*
Special Conditions and Considerations. i.e. behavior, attendance, parent separation, change in guardianship, change or loss in housing, family crisis, and health issues.  *
Did you email Mr. McPhail a copy of the suspension letter, threat assessment,  and/or behavior conference,  transcript, and current grades in the courses the student is currently enrolled in?  (If no, please do.) *
A copy of your responses will be emailed to the address you provided.
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