SLzUSD: Hesperian Elementary School COST Referral
WHAT IS COST? Each site within San Lorenzo Unified has a Coordination of Services Team (COST). Click here to learn more!


Thank you for taking time to submit this referral! Please see below regarding your input and the COST referral and service process. Please provide as much information as possible. Someone from the COST may contact you for further information before services are coordinated.

Immediate and Urgent Needs
For immediate need of emergency services, please call 9-1-1. 
Alameda County Crisis Support Services: https://www.crisissupport.org/ 
SUICIDE AND CRISIS LIFELINE - Alameda County Residents: call 1-800-309-2131 or text "Safe" or "Seguro" to 20121 (National line: call/text 988)
If you're a community member requiring additional crisis support, please see Mental Health Resources HERE.

If this is regarding a non-emergency but high-risk situation that requires immediate attention (within 24 hours), please contact your site's social worker, COST lead, and/or site administrator. COST Contact List by Site

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Email *
Name of staff, parent/caregiver, student making the referral.
Nombre del personal, padre/cuidador, estudiante que hace la referencia
进行转介的教职员工、家长/看护人、学生姓名。 *
Name of student being referred to COST.
Nombre del estudiante al que se refiere COST.
 被提及到 COST 的学生姓名。
 *
Student ID (optional not required)
Identificación de estudiante (Opcional no requerido)
学生证 (可选 非必需)
What is your relationship to student being referred?
¿Cuál es su relación con el estudiante recomendado?
您与被转介的学生是什么关系？
 *
Student grade level
Nivel de grado del estudiante
学生年级
 *
Does this student receive IEP services? 
¿Recibe este estudiante servicios del IEP?
该学生接受 IEP 服务吗？
 *
Is the student an English Language Learner?
¿Es el estudiante un estudiante del idioma inglés?
 学生是英语学习者吗？
 *
Staff/teachers: Have you discussed this referral with the students caregivers/parents? If yes, please let us know when and the outcome. If no, please explain why not and/or when you intend on engaging parent/caregiver.
* Parent/caregiver/student: please enter "n/a".

*solo para el personal de la escuela y los maestros, todos los demás continúan con la siguiente pregunta.

*仅适用于学校职员和教师，其他人继续下一个问题。
 *
Parent/Caregiver: Have you discussed this referral with your student? If no, please explain why not or when you intend on doing so.
* Staff/teachers: please enter "n/a"./

Padre/cuidador: ¿Ha hablado de esta referencia con su estudiante? En caso que no, explique por qué no o cuándo piensa hacerlo.

家长/看护人：您是否与您的学生讨论过该次转介？如果不是，请解释为什么不这样做或者您打算何时这样做。
* 教职员工/教师：请输入“n/a”。/
 *
Student: Is your caregiver/parent, teacher, or other staff member aware that you are seeking support services? If yes, please tell us who is aware. If no, please share any concerns you have with letting them know. * Staff/Caregivers: please enter "n/a"

Estudiante: ¿Su cuidador/padre, maestro u otro miembro del personal sabe que usted está buscando servicios de apoyo? En caso que si, díganos quién lo sabe. En caso que no, comparta cualquier inquietud que tenga para hacérselo saber. * Personal/Cuidadores: ingrese "n/a"

学生：您的育儿者/家长、老师或其他工作人员是否知道您正在寻求支持服务？如果是，请告诉我们谁知道。如果不是，请告诉他们您的任何疑虑。 * 职员/育儿者：请输入“n/a”
 *
Please tell us about the students strengths and interests.
Por favor cuéntenos sobre las fortalezas e intereses de los estudiantes.
请告诉我们学生的优势和兴趣。
 *
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