Please use this form to refer your student(s) for school social work services as well as additional support (academics, medical, community referrals). 

This referral form will be accessed by Griselda Soto-Valencia, School Social Worker who you may contact Monday to Friday from 8:00 a.m. - 3:30 p.m. at (661) 765-7431 ext. 163, grsoto@elkhills.org, and/or in-person. 

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Please indicate best time and method (call, email, in-person) during the day to contact you. *
Referral Date: *
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DD
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Have you made contact with Elk Hills? *
Parent/Guardian E-mail:
Please list the best phone number for parent/guardian contact. *
Student's Name: *
Student Grade: *
Please check any of the following concerns you have observed: *
Required
Please provide additional important information that could help me better understand your student's situation.
Referral Urgency: *
Required
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