LINKS Referral Request
To be completed by the student's case manager when there is a need for LINKS services.
Staff completing form
Staff email (if you want to receive a copy of your form answer)
Date of Completion
Has the parent been informed of this referral request?
What is the reason for the current LINKS referral?
In Home Therapeutic Support
Connections with community resources
Need to complete school system related documentation
Attendance concerns not already flagged through the attendance questionnaire process
What is the service or assistance being requested? Choose as many as apply.
Provide uniforms for the student
Provide non-uniform clothing for the student
Provide food assistance for the family
Provide hygeniene kit for student
Provide assistance with purchasing or assisting with medication or medication related documentation
Provide assistance with paying utility goal
Provide transportation to outside community provider
Assist family with completing school system required documentation
Provide short-term transportation to/from school while waiting for transportation services to begin
Provide parent transportation to a meeting with school staff
Provide In-Home Therapy
Provide link with community resources
Conduct attendance check-in with student/family.
If uniforms or non-uniform clothing is requested, please indicate specifically what is required and the size(s) required for each item. Be sure to indicate if the size is children's or adult's.
Should be Empty: