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Student Support

Consultation Form
Date Submitted:
Student

Grade

Teacher

Support Teachers

ESL Stage

IEP YES NO

Parents contacted Date:

Areas of Strength

Areas of Concern
concerns about academic performance

concerns about behaviour

concerns about recent social changes such as family and/or


peer relationships

would like to discuss current levels of support

would like programming suggestions

Other (please explain)

 Parents/Guardian(s) must be informed of concerns before


LST is consulted.

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