Fill in boxes completely. Please note that teacher contact with parent is required.
Last Name, First Name
Provide as much information as necessary.
Reason for Referral
Parent Contact is required for any referral
If you are suspending a student from your class, a meeting needs to be scheduled with the parent and counselor or assistant principal. Please contact the appropriate administrator with the time and place of this meeting or for assistance in this matter.
Date of parent contact
Type of parent contact
For Office Use Only
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This form was created inside of El Dorado Union High School District.
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