Family Engagement and Resource Center Referral Form

Family Engagement and Resource Center Referral Form
Purpose: Please use this form to refer a family and or student to the Family Engagement and Resource Center. Before referring a student for additional support, ensure that the school has made every effort to support the family and or student at the building with the resources available.

Referral Process

Step 1:	School provides resources to the student and or family.
Step 2:	School refers the student and or family to the FERC using the referral form.
Step 3:	FERC meets the student and family to identify the need for support and resources.
Step 4:	FERC provides the students and family the resources or directs them to resource providers.
Step 5:	FERC communicates with the building leaders or designee the support provided to the student and or family.

Student Name*

First NameLast Name
Student ID*
Student Grade*
Student School*
The person referring the student and or family for additional support from the Family Engagement and Resource Center*

AdministratorSchool CounselorSchool NursePsychologistClassroom TeacherSpecial Education TeacherParent/FamilyOther
If a staff member is providing the referral, please provide contact information:

First NameLast Name
Staff email:
example@example.com
Please provide background on the primary issue and what has already been tried to support the student and or family. Limit the description to 300 words.

0/300
What resources would you like the student/families to receive from the Family Engagement and Resource Center. Check all the apply*

Support families in enrolling in free or reduced-price meal programDistrict enrollment support for multilingual learner familiesRefer families to food, clothing, and other basic-need access via community providersSupport families, schools, and District department staff in connecting with translation and interpretation services.Educate families about various programs and opportunities in the DistrictShare information about scholarships, educational pathways, and choice programsSupport parents in preparation for parent-teacher conferencesShare opportunities and enrollment support for District sportsProvide information about high school courses and graduation requirementsFAFSA and WASFA application processConnect families and students with programs or agencies to support college essays and applications and after-school tutoringObtain a mobile hotspot from the District Technology DepartmentOther
Thank you. For questions, please contact:

Family Engagement & Resource Center
FamilyCenter@nsd.org
425.408.7814
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