Mill Park Secondary Student Wellbeing Referral

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Referrals will be discussed and allocated between the Wellbeing team.
Once it has been allocated a member of the Wellbeing team will contact you.
**PLEASE NOTE** Referral allocations occur on Tuesday mornings.

Email *

Relationship to student *

MPSC Staff

Guardian

Other:

Name of student (as it appears on Sentral) *

Is this a referral to Wellbeing OR a request for a consultation with a member of the team to self manage? (Consultation will only be available for low needs). *

Referral

Consultation

Required

Students contact number *

Senior students only

Year level *

Is the student aware of this referral? (It is important you have the conversation with the student prior to the referral, this helps the welfare team build rapport) *

Yes

Are the Parents/Guardians aware of the referral? *

Yes

Unsure

Is an interpreter required?

Yes

Clear selection

Are there any other staff involved in this referral? If so please list them below.

Reason for the referral, what are the key area/s of concern? Please include as much detail as possible. *

What has been done so far to address the concerns?

Is there anything else the Wellbeing team should be aware of?

Please give your priority rank of the student. *

Priority 1 – In immediate danger, fatal or high chance of permanent injury. Unable to keep themselves safe/emergency services required.

Priority 2 – Perceived risk of danger, likelihood of harm to self, and/or causing injury or harm to others.

Priority 3 – No immediate danger, is able to keep themselves safe and no harm to others.

A copy of your responses will be emailed to the address you provided.

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