Southern Lakes Consortium Alternative High School
School of residence Screening/Placement Request
To be completed by home school personnel:
Student Name: _____________________________________ Grade: ________________
Reason for Referral: _________________________________________________________
Court agreement regarding school attendance? __________
If yes, the agreement states: ___________________________________________________________
Can this student demonstrate the ability to respect self, others and authority? __________
Please attach a copy of the student’s transcript(s).
Please attach a copy of the student’s standardized test results.
Please attach a sheet giving a brief narrative of the student’s educational background. Include in this any modifications initiated and the impact/support these efforts provided. Comment on the relationship of this student with his peers and staff members. Please add any unique information as to why this students is being referred.
These items must be sent over to SLCAHS before the student is enrolled.