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Date: ___ Referral of Student with Possible Visual Impairment Person Making the Referral:___Name of Student:___ Age of Student: ___ Grade of Student: ___Relation to the Student: ___Birthdate: ___Phone
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01
Obtain the referral form from the appropriate source (school counselor, teacher, administrator, etc.).
02
Fill out the student's personal information including name, address, phone number, and date of birth.
03
Provide relevant background information about the student's academic performance, behavior, and any other relevant details.
04
Indicate the reason for the referral and what support or services are being requested.
05
Obtain any necessary signatures from the appropriate parties and submit the completed form to the designated recipient.

Who needs referral of student with?

01
School counselors
02
Teachers
03
Administrators
04
Special education coordinators
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Referral of student is a process in which a student is recommended or sent to a particular program or service for assistance or further evaluation.
Teachers, school counselors, administrators, or any other school staff member responsible for student welfare may be required to file a referral of student.
Referral of student forms can typically be filled out online or on paper, and must include detailed information about the student's behavior, academic performance, and any concerns or reasons for the referral.
The purpose of referral of student is to address any concerns or issues a student may be facing by providing them with the appropriate support or services.
Information such as the student's name, grade level, reason for referral, any previous interventions or assessments, and contact information for parents or guardians must be reported on referral of student.
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