New Scholar Referral

Referral Creator's Information

Referral Date * +

Your Name *

Relationship to Scholar *

Your email address *

Please briefly explain why you are referring this student to CORE: *

Scholar Last Name *

Scholar First Name *

Birthdate * +

School Name? *

Highschool Graduation Year 🛈

CCSD/ Student Number * 🛈

Scholar Email Address

Scholar Cell Phone

Parent/Guardian Name

Parent Cell Phone

Scoring: 1= Low, 5= High

See examples in pop-ups for guidance.

Family Support Needed * 🛈

Academic Support Needed * 🛈

Behavior Support Needed * 🛈

Social Emotional Support Needed * 🛈

Type

Scholar Applicant

Scholar

Former Scholar

Graduated Scholar

Status