PEI/Intervention Parent Referral
This form is used by parents to refer their child to our site interventions and Prevention and Early Intervention program. The program includes:

PEI counselor - They meet with students individually and in groups dealing with a variety of personal problems, including those related to conflict with others, depression, anxiety, grief, recent life changes, alcohol and/or drug use.

A PEI family advocate  - They meet with families to connect them with needed resources for food, housing, and other essentials, such as child care, utility assistance, and health services.

Friday Night Live coordinator - Meet once a week with the FNL club to engage youth as active leaders and resources in their communities.

TMS Counselor - They meet with students individually and in groups dealing with a variety of academic and personal problems, including those related to grades, working with teachers, conflict with others, depression, anxiety, grief, recent life changes, alcohol and/or drug use.

Intervention Specialist - They meet with students individually and in groups for academic support.

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Student Name *
Student Grade *
Required
Your name and contact information (please include either an email or cell) *
What type of help do you need? *
Required
Please let us know more information about the issues you are facing and the assistance you need. *
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