EastLake Middle School Restorative Practice Parent Referral Form

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Parents, please fill in the form below to refer your student for a Restorative conversation with Ms. Quinn. Restorative conversations help to build relationships, alleviate anxiety and stress and can help students to feel more connected during distance learning.

Student ID Number *

Student Last Name *

Student First Name *

Parent Name (Last, First) *

Does the student regularly attend synchronous learning sessions? *

Yes

Why are you referring your student? *

What is the best phone number to contact your student? *

What additional information would you like me to know about your student? *

Submit

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