Referral Form
Referral for:
ROE logo

Student Being Referred

Mailing Address
Mailing Address
City
State/Province
Zip/Postal
Physical Address same as Mailing Address?
Physical Address
Physical Address
City
State/Province
Zip/Postal

Parent/Guardian Information

Basis of Referral

Additional Bases
Because you selected Expulsion:

Please submit all documentation including acts of gross misconduct and/or disobedience which threatened the safety of other students, staff, faculty, or the school community.

Maximum file size: 314.57MB

Other Services

Has Special Education eligibility ever been identified
504 Plan Identified
Food Allergies
Select Food Allergy
Medical Authority Modified Meal Form

Maximum file size: 314.57MB

Academic and Behavioral Data

Constitution Requirement Fulfilled
Has the student been referred to Truancy?
ECHO Junior High students must have a Truancy referral. Please remember to submit a referral here: https://truancy.roe21.org

District Information

Upload all relevant attendance, behavior, and academic records.

Maximum file size: 314.57MB

To ensure the referral is reviewed thoroughly and a registration meeting can be scheduled in a timely manner, please verify that all information in the form is correct and that all necessary documentation is included.