Thompson School District SWAP Referral Form

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Referral Form for students that may benefit from School to Work Alliance Program support. Please complete and submit.

First name *

Last Name *

phone number

Is it okay for SWAP to text the student?

Yes

Clear selection

Student email

Student's Grade Level *

Referring School or Agency *

Referring Person *

IEP or 504

IEP

504

Neither

Clear selection

Student Status *

Enrolled in High School

Thompson Career Campus

Enrolled in Transition Services

Graduated

Risk of dropping out of high school

Enrolled Post Secondary Education

Other:

Reason for Referral (check all that may apply) *

Self-Advocacy Skills Training

Interest and Skills Assessments

Career Exploration Counseling

Exploring Post-Secondary Options

Job Shadows

Job Seeking Skills Training

Active Job Searching

Job Retention Counseling

Financial Literacy Training

Required

Student's Disability *

Learning

Emotional

Behavioral

Physical Health

Speech Language

Traumatic Brain Injury

Required

Legal History *

Yes

If yes to Legal History, briefly explain.

Details to help SWAP better understand the student's strengths, needs, or goals.

What else should we know about the student?

How did you hear about SWAP or DVR?

Submit

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