eDCSD Counselor Recommendation Form
Please answer the questions to the best of your knowledge. Your answers will be kept confidential.
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
School *
Your answer
Counselor Name *
Your answer
Peer Interactions *
Lowest
Highest
Comments
Your answer
Self-Motivation *
Lowest
Highest
Comments
Your answer
Self-Advocation *
Lowest
Highest
Comments
Your answer
Family Situation *
Lowest
Highest
Comments
Your answer
Does the student receive any of the following services? *
Required
If yes, please list the case manager's name *
Your answer
Are there any safety concerns/considerations? *
Required
Are there any mental health concerns? *
Required
If yes, and they working with an outside provider, please provide a contact.
Your answer
If there's mental health concerns, please comment.
Your answer
If there's additional information, please add here.
Your answer
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