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MARS/MARESA Student Success Referral Form
Please complete this entire referral form to initiate support from our Student Success Advocate.
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* Indicates required question
Email
*
Your email
Student Full Name
*
Your answer
School District
*
Choose
AuTrain-Onota Public Schools
Burt Township Schools (Grand Marais)
Gwinn Area Community Schools
Ishpeming Public Schools
Marquette Area Public Schools
Munising Public Schools
Negaunee Public Schools
NICE Community Schools
North Star Montessori Academy
Powell Township School District
Republic-Michigamme Schools
Superior Central School District
Wells Township School District
Father Marquette Catholic Academy
Grade in School
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
12+ Post-HS Special Education
Unknown
Reason for Referral (check all that apply)
Completely disengaged from learning
Truancy/Poor Attendance
Poor Academic Performance
Physical health/safety concerns
Mental health/social/emotional concerns
Educational concerns related to housing instability
Other:
Reason student disengaged from learning (if known)
Your answer
Referred by (Full Name and contact information)
Your answer
Relationship to student
Choose
Family Member
Friend
School Personnel
Other
Parent/Guardian Full Name
*
Your answer
Family's Address
Your answer
Family's Phone Number
*
Your answer
Family Email Address
Your answer
A copy of your responses will be emailed to the address you provided.
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