Sierra High School Request for Interventions 2026-2027
Please use this form as a request for intervention. All interventions will be pre-screened so the student can be placed in the appropriate program or service.

This sheet is checked daily. 
Email *
Staff Name *
Student First Name *
Student Last Name
Student ID *
Session *
Primary Area of Concern (root cause) *
Secondary Area of Concern/ Comments
COUNSELOR/ADMIN ONLY - THIS REFERRAL CAME AS A RESULT OF
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