Behavior Specialist Referral Form

Make sure your school's behavior specialist is well-informed by filling out this form when you refer an individual to him or her. The form provides a checklist of behaviors, an academic checklist, and a list of environmental factors to consider.

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Instructional Ideas

  • Pair this with additional records on interventions you may have already implemented to give the specialist a full understanding of the situation
Classroom Considerations

  • The form states that a the behavior specialist is here to support elementary students, but this form could likely be used with older pupils as well
  • Since this provides checklists and an area for a brief explanation, you may wish to attach more explanation for some of the behaviors

  • The form is clearly formatted
  • Covers a wide variety of behaviors and academic and environmental concerns to check off



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