Coyote Strong Referral

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Coyote Strong is a health & wellness and substance abuse prevention program. Our goal is to identify at-risk and high risk students, and to involve them in prevention related activities.

When identifying a student, pay attention to behaviors that are uncharacteristic/unusual for that particular student. Always go with your instinct when referring a student, for we would rather have a stack of referrals to deal with than miss a student that is beyond the scope of prevention.

Email *

Your Name *

Student Name *

Student ID # *

Please Check All That Apply *

Drop in grades / low academic performance

Aggressive Behavior (outburst, disruptive behavior)

Peer Rejection

Absenteeism/ Tardiness

Lying, Cheating, Sneaky behavior

Other:

Required

Description of Situation

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This form was created inside of Mesa Public Schools. Report Abuse

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