Bug Referral
After school BUG homework and tutoring assistance provided by Zia teachers and support staff.
Individual Making Referral
*
First Name
Last Name
Student Name
*
First Name
Last Name
Grade Level
6
7
8
Parent e-mail
example@example.com
Parent Phone Number
Format: (000) 000-0000.
Tutoring Subject
Please Select
English
Elective
Math
Science
Social Studies
Please provide the course(s), teacher(s), and name of assignments the student should work on in BUG. A counselor will contact the parent and teachers so they are aware of the referral.
*
Submit
Should be Empty: