WSS CORE REFERRAL
The information collected through this referral will be used to determine students in need of intervention. You may be contacted for additional information about a referred student if/when they are discussed at a weekly CORE meeting.
Name of Referring Teacher (first/last name)
Student Name (first/last name)
If there is a CEA in the classroom supporting this student, please specify:
Dona Haws/Jessica Dennison
Theresa Hammerquist/Gillian Baltakis
Melody MacRae/Gillian Baltakis
No CEA scheduled in this clas
Current Mark % (approx)
Which of these interventions have you tried?
Review IEP when applicable and student file
Used various in-class learning strategies
Contacted parents (email with response from parents or phone call)
Contacted counsellor/case manager/administration
Check all concerns that apply
Struggling with Content
Behaviour (refusal to work, disruptive/distracting, inappropriate peer interactions, verbal disrespect, please specify below)
Please provide details about your concerns and strategies you have tried.
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This form was created inside of School District 73.