Placer High School 2018/19 CoST (Collaboration of Services Team) Referral
Email address *
CONFIDENTIAL REFERRAL FOR STUDENT SUPPORT
THIS REFERRAL IS NOT TO BE PART OF ANY STUDENT'S EDUCATIONAL RECORD.
Today's Date *
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Your Name *
Your answer
LAST NAME of student you are referring (if you are a student seeking services for yourself, enter your Last Name here) *
Your answer
FIRST NAME of student you are referring (if you are a student seeking services for yourself, enter your First Name here) *
Your answer
Are you concerned about this student's immediate safety? *
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