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Recommendation Form

Student Recommendation Form

We value confidentiality therefore the information you are about to submit will be sent directly to the CIS Student Support Manager and/or Specialist (SSM /SSS) at the student's campus. The SSM/SS will follow up with the student and may follow up with you if further information is needed. 
This question requires a valid number format.
5. Contact information for person making the recommendation: *This question is required.
6. Relationship to Student *This question is required.
7. Check all areas of concern for this student and provide as much information as possible on question #8 to assist in determining the best course of CIS services. 

When the student receives appropriate consent, CIS staff will develop a service plan and coordinate appropriate services for the student. The student may be served at school or referred to an outside agency for services. 
  *This question is required.