Clear Creek Independent School District R-1 - 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, teacher's name, and grade in the designated fields at the top of the form.
3. Fill in the parent’s name, school, address, and contact information. Ensure all details are accurate for effective communication.
4. In the 'Reason for Referral' section, briefly state the reason for referral such as academic or behavioral issues. If applicable, attach any required documentation.
5. Complete the Home Language Survey and provide results if applicable. Attach any necessary reports for limited English proficient students.
6. For Academic Performance, attach attendance documentation and grades. Fill in recent achievement test scores and other relevant school experiences.
7. Address health information by filling out vision and hearing details. Indicate if there are any concerns regarding these areas.
8. Finally, ensure all committee members sign off on their decisions regarding referrals and interventions before submitting your completed form.

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