Catahoula Alternative School Referral
Student Information
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Student's Full Name *
Gender *
School *
Grade *
Is this a Special Education student? *
Is this student 504? *
If yes, please list modifications.
Does this student have any known medical issues? *
If yes, please explain.
Does this student take medication at school? *
If yes, please list medications.
Does this student have any know allergies? *
If yes, please explain.
Lunch Status *
Please select the meals the student will eat.
Transportation Arrangements *
If riding the bus, what is the driver's name?
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