SCIP Student Referral (step one) CONFIDENTIAL
Complete this form if you have a concern about a student. The SCIP team will meet and discuss next steps. If you would like to make the referral in person, please contact East High at 402-436-1302 and ask for Diane Wilson-Dunning.
Email address *
Student Name: *
Your answer
Student ID:
Your answer
Student Grade *
Relationship to student: *
Reason for Concern: (Please give as much detail as possible to help guide the SCIP team) *
Your answer
OTHER INFORMATION
Your answer
Name of person referring (Optional)
Your answer
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