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CTARS Referral Form

Use this form to refer a student to the CTARS team for consideration of Worksheet 2 interventions.


Have you submitted Worksheet 1 for this student?
If you haven't completed Worksheet 1 on the OCR website, please complete it before submitting this form. Office of Civil Rights Compliance (
Student First Name 
Student Last Name 
Student ID 
Teacher First Name 
Teacher Last Name 
Teacher's Email Address 

* denotes a required field