REASON FOR REFERRAL Sample Clauses

REASON FOR REFERRAL. Disruptive Behavior Teen Parent Inability to function appropriately in school Parent Request Substance Abuse _ Special Education Needs Expulsion I Mandatory Non-Mandatory Runaway Medical _ Social Services Truancy (4 Dates: Other (Describe): S1S 2022
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REASON FOR REFERRAL. A brief description of the problem(s)/need(s) that brought the consumer/client to the agency in which you are placed (this should include the individual/agency who referred the client/consumer to your agency)
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REASON FOR REFERRAL. □ ODisruptive Behavior OTeen Parent Inability to function appropriately in school OParent Request Substance Abuse Ospecial Education Needs 0 ExpulsionOMandatory ONon-Mandatory ORunaway OMedical social Services 0Truancy {4 Dates: Oother (Describe): D AItfEMPtfED INtfERVENIIONS PREVIOUS ,EDUAtfIONAL ALtf,ERNAIIVES Educational Counseling 0SARB OContinuation High School OWork Experience OSchedule Modifications OSuspension days OAdult Education OESL/LEP Bilingual OParent Conferences O0ther OR.O.P. O0ther Comments: NIA for Pacific Coast High School □ RECOMMENDAtfION: ADMINUNIT: @C'HEP/PCHS OGarden Grove DHarbor Learning Center ONorth OSouth East Sunburst □ □ □ Pleas� check box ifaJ!12lkable : (For Office Use Onlx) Section 1981 (c) □ OSection 1981 (a) District Expulsion (1) Probation status 0601 0602 0654 Section 1981 (b) SARB 12s 0126 121 0790 Section 1981 (d) Parental Request/District Approval (2)0On probation or parole and not in attendance in any school (s)OExpelled: Section 48915 (a) or (c) REFERRAL - REVIEW & CERtfIFICAtfION Referring District/School Print CWA/Designee Name and Title Signature Date OCDE Representative Probation Representative Print Name and Title Print Name and Title Signature Signature Date Date Certi(!:..ed 'f!.ttrsttant to Orange Co1111ty J11ve11ile Cottrt Order Filed December !iI, !2001 Pacific Coast High School Xxxxxxx Xxxxxxx, Principal Juvenile Court Representative Parent Guardian Caregiver Date Student Sie:nature Date CC: Connnumty School (Wlute), OCDE REP (Yellow), District or Probation (Pmk), Parent/Guardian/Caregiver (Goldenrod) Form100:10/2s/18 July-August Trimester 2020 COURSE LOGIN DIRECTIONS SAVE THIS PAGE! Courses WILL NOT be available until 7/1/20 For Canvas login support, please email Xxxxxxx at xxxxxxxxxxx@xxxx.xx.
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