Student Intervention Referral
If students are caught vaping or using nicotine, cannabis or other drugs products on campus, please use this form to refer them to an intervention. Use this form for voluntary students as well.
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Email *
Your Role at the School
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Today's Date
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Student Name
Why is student being referred?
Student School
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Student Grade
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What product was student caught with?
Enrolling student in other intervention services? 
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Preferred Date and Time to Meet with Student (optional, if using standard BCOE intervention services )
How does the intervention specialist contact student? Special Considerations? Notes? (optional, if using standard BCOE intervention services)
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