The Restore Program - Student Enrollment Form

Through comprehensive care and support, The Restore Program team invests in students and parents through restorative meetings to make agreements.

Schools and agencies can fill out this enrollment form as soon as attendance issues arise and our Focus Team will contact the student's parents. Our team will contact the family and begin services within 48 hours. Making this referral is the only step you need to take for chronic absenteeism among students to ensure a referral is made. Thank you for your time, we'll be in touch and take it from here!

Email Address (of school or county contact)

STUDENT INFORMATION

First name

Last name

Street Address

ZIP Code

Date of Birth

Month

Day

Year

Age

Gender

Grade

Preferred Pronouns

Student's Ethnicity

Hispanic or Latino

Non Hispanic or Latino

Name of School

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YOUR JOURNEY STARTS NOW

Click on the appropriate program referral below,
fill out the form and we
will be in touch within 24-48 hours.

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The Restore Program - Student Enrollment Form

Click on the appropriate program referral below, fill out the form and we will be in touch within 24-48 hours.

Click on the appropriate program referral below,
fill out the form and we
will be in touch within 24-48 hours.