CIS PARTICIPANT RECOMMENDATION FORM
School Year 2022-2023
Student Name
*
First Name
Last Name
Grade
*
Please Select
Prek
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
District
*
Please Select
Bonham
Carrollton/Farmers Branch
Crandall
Dallas
Denison
DeSoto
Greenville
McKinney
Midlothian
Plano
Rains
Richardson
Sherman
Terrell
Bonham ISD Campus
*
Please Select
Finley Oates Elementary
I.W. Evans Intermediate
L.H. Rather Junior High School
CFBISD Campus
*
Please Select
Blair Elementary
Carrollton Elementary
Central Elementary
Creekview High
Landry Elementary
Long Middle
McLaughlin/Strickland Elementary
Newman Smith High
R.L. Turner High
Ranchview High
Sheffield Elementary
Vivian Field Middle
Crandall ISD Campus
*
Please Select
Crandall High School
Crandall Middle School
Dietz Elementary
Martin Elementary
Noble Reed Elementary
Walker Elementary
Wilson Elementary
Dallas ISD Campus
*
Please Select
Ann Richardson STEM Academy
Atwell Middle School
Benjamin Franklin International Exploratory Academy
John Lewis Social Justice Academy at Oliver Wendell Holmes
Lang Middle School
Lincoln High School
Madison High School
Molina High School
Roosevelt High School
Rusk Middle School
Saldivar Elementary
School for T&G in PG
Seagoville High School
Skyline High School
Spruce High School
Thomas Jefferson High School
Denison ISD Campus
*
Please Select
Denison High
Scott Middle
DeSoto ISD Campus
*
Please Select
Crockrell Hill Elementary
DeSoto High
DeSoto West Middle
Frank Moates Elementary
McCowan Middle
The Meadows Elementary
Woodridge Elementary
Ennis ISD
*
Please Select
Dorie Miller Intermediate
Ennis Junior High
Ennis High School
Jack Lummus Intermediate
Greenville ISD Campus
*
Please Select
Bowie Elementary
Carver Elementary
Crockett Elementary
Greenville High School
Greenville Middle School
Lamar Elementary
LP Waters Early Learning Center
New Horizon High School
Travis Elementary / 6th Grade Center
Grand Prairie ISD
*
Please Select
Adams Middle School
Bonham Early Childhood Center
Dubiski Career High School
Fannin Middle School
Grand Prairie Fine Arts Academy
Grand Prairie High School
Jackson Middle School
South Grand Prairie High School
McKinney ISD Campus
*
Please Select
Boyd High School
Burks Elementary
Caldwell Elementary
Finch Elementary
HL Early Childhood
Malvern Elementary
McKinney High School
McKinney North High School
McNeil Elementary
Minshew Elementary
Press Elementary
Reuben Johnson Elementary
Slaughter Elementary
Vega Elementary
Webb Elementary
Midlothian ISD Campus
*
Please Select
Frank Seale Middle
J.A. Vitovsky Elementary
J.R. Irvin Elementary
Plano ISD Campus
*
Please Select
Armstrong Middle School
Bowman Middle School
Carpenter Middle School
Christie Elementary
Daffron Elementary
Forman Elementary
Frankford Middle School
Jackson Elementary
Mendenhall Elementary
Mitchell Elementary
Otto Middle School
Rasor Elementary
Renner Middle School
Rose Hagger Elementary
Thomas Elementary
Wilson Middle School
Rains ISD Campus
*
Please Select
Rains Elementary
Rains High School
Rains Intermediate
Rains Junior High
Richardson ISD Campus
*
Please Select
Apollo Junior High School
Audelia Creek Elementary
Bukhair Elementary
Forest Lane Academy
Forest Meadow Junior High School
J.J. Pearce High School
L.V. Berkner High School
Lake Highlands High School
Lake Highlands Junior High School
Liberty Junior High School
Northlake Elementary
Parkhill Junior High School
Richardson High School
Richardson North Junior High School
Richardson West Junior High School
Skyview Elementary
Stults Rd. Elementary
Westwood Junior High School
Sherman ISD Campus
*
Please Select
Crutchfield Elementary
Dilingham Elementary
Fairview Elementary
Neblett Elementary
Piner Middle
Sherman High
Sherman Middle
Sory Elementary
Wakefield Elementary
Washington Elementary
Terrell ISD
*
Please Select
Furlough Middle School
Terrell High School
Please mark all areas of concern for this student.
Academics
Attendance
Behavior
Social Service Needs
Please provide as much information as possible about the concerns checked above to best assist in planning services.
My relationship to this student is:
*
CIS Staff
Self-Referral
Teacher
Parent
Principal
Assistant Principal
School Counselor
Law Enforcement
Peer
School Nurse
Juvenile Court
Texas Youth Hotline
Other
Recommendation Source Name (printed):
*
Email
example@example.com
Contact number:
*
Please enter a valid phone number.
The best time to reach me is:
*
Morning
Afternoon
Evening
Convenient time:
Signature:
*
Clear
Date:
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: