333 S. Beaudry Ave. | Los Angeles, CA 90017 | T 213.241.1000 | www.lausd.net
Student Support and Progress Team Request Form
(Submit to SSPT Designee)
Date:
____________________________
School: _________________________________
Referring
Person:
____________________________
Relationship
to student: _________________________________
Position:
(if applicable)
____________________________
Dates/Times available
for consultation: ___________________________
Student
Name:
____________________________
Student ID: _________________________________
Grade:
____________________________
English Learner: Yes No
Reason for Referral:
Academic
Behavior
Health
Language
Social/Emotional
Reclassification
Brief Description of Concern:
The SSPT Designee will contact you to schedule a consultation meeting.
ATTACHMENT F