ITINERANT FRESHMAN ACADEMIC COUNSELOR

Status of Your Referral of_____________________________________________

Thank you for your recent referral. The item(s) checked below
indicates the current status of this individual. If additional
information is needed please feel free to speak to me during your
planning period.

[ ] In-school assessment process has begun. Input from

additional staff members has been requested.

[ ] Student has been referred to a community agency for

assessment and/or evaluation.

[ ] Student is now involved in periodic counseling sessions

with his/her counselor.

[ ] Student has been referred to the Social Worker in the

Special Education Department

[ ] Home has been contacted to seek additional input.

[ ] Academic Progress Plan completed and implemented.

[ ] Student has been referred to a treatment/rehabilitation

program and will be absent from classes until further
notice.

[ ] Behavioral Plan completed and implemented.

[ ] Assessment indicates that no further action is needed at

this time.

[ ] Other: _____________________________________________________

____________________________________________________________

IFAC ____________________________________ Date_________