InfoTech

Ombudsman Program

This form is for recommending an "at-risk" student for the Ombudsman Program.

Please check all applicable options, and optionally, provide additional notes/explanations.

Please fill out all the required fields marked with red

Name: Email:

Characteristics of an At-Risk Student

Student Name:

Academics

Does the student demonstrate significant academic concerns?

Yes No

Social/Emotional

Does the student demonstrate significant social/emotional concerns?

Yes No

Poor self-esteem Uninvolved in school activities No friends in school Dislikes school overall Family issues impacting school success Demonstrates depression symptoms Frequent health/hygiene referrals Possible abuse, neglect Poor coping, problem solving ability

Aditional comments

Attendance/Discipline

Does the student demonstrate significant attendance/discipline concerns?

Yes No

Frequent absences/tardies Negative peer influences Suspended/expelled two or more times Substance abuse issues Frequent disruptions in school Disrespects authority Threatens peers, school staff Limited positive adult influences History of transience

Aditional comments

Ombudsman Program

Welcome to Ridgewood's Info Tech Website! InfoTech forms are for Ridgewood High School faculty, staff and authorized users ONLY!

Welcome to Ridgewood's Info Tech Website! InfoTech forms are for
Ridgewood High School faculty, staff and authorized users ONLY!