| Student Re-Entry Guide | ||
| *Asterisk denotes drop-down list |
Student Inmation:
| ||
| Student Name: | ID: | Date: |
| School: * | Grade: * | |
Meeting Information:
| |||
| Meeting Scheduled for: | Date | Time | Meeting Location: |
Initial Checklist
| |||
Yes
| No
| ||
| Release of Information(s) Completed? | ☐
| ☐
| Provider(s): |
| Did Student Receive In-Patient Services? | ☐
| ☐
| Provider:
Placement: (Admitted Date) to (Discharge Date) |
| If yes, was provider contacted? | ☐
| ☐
| In-Patient Client Code: |
| Is Student Receiving Outside Counseling? | ☐
| ☐
| Provider: |
| If yes, was provider contacted? | ☐
| ☐
| |
| If no, has referral been completed if
necessary? | ☐
| ☐
| Provider:
Date of referral: |
| Is Student receiving services through a 504 Plan or IEP? | ☐
| ☐
| Which: |
| Team Members Invited to Meeting? | ☐
| ☐
| Invited: Administrator, Counselor, Parent, Student, Mental Health Provider (if applicable), other support staff (if applicable), CPS (if applicable) |
| Is a 504 Plan Referral Needed?
504 Procedural Handbook | ☐
| ☐
| If yes, who will initiate referral: |
| Student Initial Support Plan Needed? | ☐
| ☐
| If yes, date completed: |
| Student Safety Plan Needed? | ☐
| ☐
| If yes, date completed: |
| Student Supervision Plan Needed? | ☐
| ☐
| If yes, date completed: |
| Teacher(s) and Support Staff Notified of Initial Support Plan, Student Safety Plan, and/or Temporary Support Plan (if appropriate) | ☐
| ☐
| Staff responsible for notification: |
(Please provide building administrator with a copy of checklist following the meeting)
Re-Entry Meeting
Meeting Information:
| |
| Meeting Date: | Meeting Time: |
Meeting Participants:
| ||
| Name: | Role: | If “Other” please identify |
| * | ||
| * | ||
| * | ||
| * | ||
| * | ||
| * | ||
| * | ||
| * | ||
Information Gathering:
|
| Student Input |
| Do you have concerns about returning to school?
|
| Who do you want to know about your absence?
|
| What information is okay to tell them?
|
| Who is a teacher or other adult in school you feel like you can go to if needed?
|
| How can your school team best support you?
|
| Family Input |
| Do you have any academic concerns?
|
| Do you have any social emotional and/or mental health concerns?
|
| Do you have any additional comments or concerns?
|
| School Input |
| Do you have any academic concerns?
|
| Do you have any social emotional and/or mental health concerns?
|
| Do you have any additional comments or concerns?
|
| Provider Input and Recommendations (if available): |
| Follow up meeting scheduled for: |
| If not scheduled, please explain: |