Parent Referral Form
Please complete this form if you have concerns that could be addressed by our academic interventionist or our social worker. These forms will be reviewed by the Intervention Team every 2 weeks, and we will reach out to you with a plan of how to support your student. If your concern needs immediate attention, please contact our counselor, Mr. Hentes (jhentes@gbcs.org) or our coordinator, Mr. Keilitz (kkeilitz@gbcs.org).
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Date *
MM
/
DD
/
YYYY
Parent Name *
Student First Name *
Student Last Name *
Student ID *
Please check concerning behavior *
Required
Please share any additional information we may need to determine how to support your student.
What is the best way for us to contact you?
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