FAST/Wellness Referral

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Black Oak Mine USD is focused on positive outcomes for all students and families in our community. The Family and School Together (FAST) Coordinator and team members are able to assist any student, teacher, and/or family in connecting to resources and services needed for supporting better achievement. Referrals can from staff, parents, teachers, or even students themselves. Please complete the form regarding how we can help.

Email *

Student Name *

Grade *

Area of Concern *

1 point

Medical, Dental, or Vision Supprts

Family Conflict

Transition to adulthood

Self-Esteem/Victimization

Bullying/Violence

Household Support

Visit Community Resource Closet

Support connecting to school community

Temporarily Displaced

Life Skills

Career Guidance

Request specific household items

Connecting to the HUBS

Social Skills

Discipline/Defiance

Substance Abuse

Attendance/Truancy

Educational Supports

CalFresh supports

Other:

Required

Additional information you would like to share: *

Best time and day for you to visit the Community Resource Center and Wellness Center for support:

What is the best way to connect with you? Please enter your email or phone number for FAST/WELLNESS to reach out to you. *

Thank you for your time and supporting the students in BOMUSD

Email bisham@bomusd.org or Text/Call Bridget Isham at 530-334-3305 with questions or additional concerns.

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