CORE Referral & Information Gathering
The information collected through this survey 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.
In the space below, please enter the name of the student that you are most concerned about.
Note: If you have concerns about more than one student, please complete and submit this form for each student.
What is your primary concern about this student?
Achievement (due to incompletes assignments)
Achievement (due to difficulties with the course content)
I have no concerns about this student
What Level 1 supports and interventions have you implemented to support this student?
Implemented adaptations according to the IEP (if student is ministry identified)
Met with student to share concerns
Offered CEA support during class (If there is a CEA assigned to your class)
Offered support outside of class time
Encourage student to join Peer Tutoring or attend Student Connections
Consulted student's case manager or counsellor
Directed student to attend Connections
No supports or interventions have been necessary
Have you contacted parents to discuss your concerns? Please note the date of contact below.
Briefly outline the parent's response.
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