Academic Reset Referral Form 

The Academic Reset Program is an after-school Tier 2 intervention to help students organize, complete, and make up academic work. Please use this form to refer a student to this program.

Who is this program for?

  • Students who are struggling to complete work independently at home
  • Students who have lagging skills in prioritization, organization, and time management
  • Students who don’t necessarily need content retaught to them, but who need time, space, and accountability to get their work completed
When/where does the program meet?
  • The program will meet on Tuesdays and Thursdays from 2:05 to 3:00 in Room 220.
  • Students will need to get their own transportation home.

Email *
Student Name
Grade:
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Why is student being referred?
Student strengths:
Based on your conversation with the student about the program, how willing are they to participate?
Not willing
Very willing
Clear selection
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