PATH Prevention Centralized Student Enrollment Form
PATH Prevention comprises two local organizations (TreeHouse & The Katallasso Group - SHIFT) working together to guide and empower students and families in school success. By offering a continuum of care and support, the PATH Prevention team invests in students and parents through restorative meetings to make agreements, case management, mentoring, family mediation, and support groups for all.

Schools can fill out this centralized enrollment form and our joint team will contact parents (for both offices). Our team will assess the best starting point and provide seamless services.  Making this referral is the only step you need to take for truancy prevention and ensuring a referral is made to TreeHouse or The Katallasso Group, we'll take it from here and keep you posted!

Sign in to Google to save your progress. Learn more
Email *
STUDENT INFORMATION
First Name *
Middle Name
Last Name *
Street Address *
Enter the address of where the student lives MOST of the time
City
State/Province
Zip/Postal Code *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Grade *
Select student's grade
Gender
Select student's grade
Clear selection
Preferred Pronouns
Who does the student live w/ most of the time? *
Required
Student's Race (check all that apply) *
Required
Student's Ethnicity *
Name of School *
School Street Address
City
State/Province
Zip/Postal Code
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms