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Office of K-12 Educational Services 2026
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- Click ‘Get Form’ to open the School Referral Form in the editor.
- Begin by entering the 'Referral Date' and 'Referring Party' information at the top of the form.
- Select the 'Referral Reason' by checking one or more boxes that apply, such as Counseling or Legal.
- Indicate if the student is in danger or at risk of harming themselves or others by selecting 'Yes' or 'No'. If 'Yes', follow your school district’s protocol for a suicide risk assessment.
- Fill in the 'Family Information' section with details about the student, including their name, school, date of birth, and grade.
- Provide parent(s) names, contact numbers, preferred contact times, and language preferences.
- Indicate the recommended time frame for contacting the family regarding an appointment.
- Confirm whether verbal consent for services was given by selecting 'Yes' or 'No'. If 'No', provide an explanation.
- Complete the 'School Referring Party Information' section with your contact details for follow-up.
- Finally, provide a detailed reason for referral and describe any actions already taken to address the issue before submitting.
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