Alcona Student Concern Referral (Parent/Guardian/Community Agency Rep.)
If you have a concern about a student, please complete this form. The Student Success Team will meet to evaluate all referrals and recommend a plan of support.
Student's First Name
Student's Last Name
Person making the referral (Please include first and last name)
Relationship to the student
Community agency representative
Preferred contact method
Reason for Referral
Aggressive Behavior - Student is physically and/or verbally aggressive towards adults and/or peers.
Attendance Concerns - Student has erratic or inconsistent attendance.
Academic Concerns - Student is failing or falling behind academically.
Withdrawn - Student is isolated, unwilling to participate, and/or unresponsive to others.
Untended - Student has unmet physical, social, and/or emotional needs including hygiene (short of neglect).
Crisis Situation - Student has gone through a crisis (divorce, death, remarriage, change in living situation, illness, imprisonment, etc.)
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This form was created inside of Alcona Community Schools.