Office of K-12 Educational Services 2026

1. Click ‘Get Form’ to open the School Referral Form in the editor.
2. Begin by entering the 'Referral Date' and 'Referring Party' information at the top of the form.
3. Select the 'Referral Reason' by checking one or more boxes that apply, such as Counseling or Legal.
4. 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.
5. Fill in the 'Family Information' section with details about the student, including their name, school, date of birth, and grade.
6. Provide parent(s) names, contact numbers, preferred contact times, and language preferences.
7. Indicate the recommended time frame for contacting the family regarding an appointment.
8. Confirm whether verbal consent for services was given by selecting 'Yes' or 'No'. If 'No', provide an explanation.
9. Complete the 'School Referring Party Information' section with your contact details for follow-up.
10. Finally, provide a detailed reason for referral and describe any actions already taken to address the issue before submitting.

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