Student Referral – Hidden Oaks Elementary School
Student Referral - Hidden Oaks Elementary School
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Your Information
Please make sure you complete this section with “YOUR” information so we can keep you updated with the progress of this referral and contact you if need be. Thank you.
First Name
*
Last Name
*
Email Address
*
Phone Number
*
How would you like to receive notifications?
Email
Text
Both
Relationship to Student
*
Counselor
Case Manager
Social Worker
Teacher
Family Liaison
District Staff
Student Information
Please make sure to fill out this section fully so we can ensure that care package is delivered to the correct student. Thank you
Agency/School Name
*
Agency/School Name
Acreage Pines Elementary
Addison Mizner Elementary
Adult Education Center
Alexander W. Dreyfoos Jr. School of the Arts
Allamanda Elementary
Atlantic Community High
Bak Middle School of the Arts
Banyan Creek Elementary
Barton Elementary
Beacon Cove Intermediate
Bear Lakes Middle
Belle Glade Elementary
Believers Academy Charter
Belvedere Elementary
Benoist Farms Elementary
Berkshire Elementary
Binks Forest Elementary
Boca Raton Community High
Boca Raton Community Middle
Boca Raton Elementary
Boynton Beach Community High
Calusa Elementary
CARP
Carver Community Middle
Cholee Lake Elementary
Christa McAuliffe Middle
Citrus Cove Elementary
Clifford O. Taylor/Kirklane Elementary
Congress Middle
Conniston Community Middle
Coral Reef Elementary
Coral Sunset Elementary
Crestwood Middle
Crosspointe Elementary
Crossroads Academy
Crystal Lakes Elementary
Cypress Trails Elementary
Del Prado Elementary
Delray Full Service Center
Diamond View Elementary
Discovery Key Elementary
Don Estridge High Tech Middle
Dr. Mary McLeod Bethune Elem.
Dwight D. Eisenhower Elementary
Eagles Landing Middle
Egret Lake Elementary
Elbridge Gale Elementary
Emerald Cove Middle
Equestrian Trails Elementary
Everglades Elementary
Forest Hill Community High
Forest Hill Elementary
Forest Park Elementary
Freedom Shores Elementary
Frontier Elementary
Galaxy Elementary
Glade View Elementary
Glades Central Community High
Gold Coast Community School
Golden Grove Elementary
Gove Elementary
Grassy Waters Elementary
Greenacres Elementary
Grove Park Elementary
H. L. Johnson Elementary
Hagen Road Elementary
Hammock Pointe Elementary
Heritage Elementary
Hidden Oaks Elementary
Highland Elementary
Highridge
Hope-Centennial Elementary
Howell L. Watkins Middle
Independence Middle
Indian Pines Elementary
Indian Ridge School
Intensive Transition West (Crossroads)
J. C. Mitchell Elementary
Jeaga Middle
Jerry Thomas Elementary
John F. Kennedy Middle
John I. Leonard High
Jupiter Community High
Jupiter Elementary
Jupiter Farms Elementary
Jupiter Middle
K. E. Cunningham/Canal Point Elementary
Kelly Center
L. C. Swain Middle
Lake Park Elementary
Lake Shore Middle
Lake Worth Community High
Lake Worth Middle
Lantana Community Middle
Lantana Elementary
Liberty Park Elementary
Lighthouse Elementary
Limestone Creek Elementary
Lincoln Elementary
Loggers Run Community Middle
Loxahatchee Groves Elementary
Manatee Elementary
Marsh Pointe Elementary
Meadow Park Elementary
Melaleuca Elementary
Morikami Park Elementary
New Horizons Elementary
North Grade Elementary
North Transition Elementary (Gold Coast)
Northboro Elementary
Northmore Elementary
Odyssey Middle
Okeeheelee Middle
Olympic Heights Community High
Omni Middle
Orchard View Elementary
Osceola Creek Middle
PACE Center for Girls
Pahokee Elementary
Pahokee High
Pahokee Middle
Palm Beach Central High
Palm Beach Gardens Community High
Palm Beach Gardens Elementary
Palm Beach Lakes Community High
Palm Beach Public
Palm Beach Virtual
Palm Springs Community Middle
Palm Springs Elementary
Palmetto Elementary
Panther Run Elementary
Park Vista Community High
Pierce Hammock Elementary
Pine Grove Elementary
Pine Jog Elementary
Pioneer Park Elementary
Pleasant City Elementary
Plumosa School of the Arts
Poinciana Elementary
Polo Park Middle
Riviera Beach Preparatory and Achievement Academy (was Roosevelt Full Service Center)
Rolling Green Elementary
Roosevelt Community Middle
Roosevelt Elementary
Rosenwald Elementary
Royal Palm Beach Community High
Royal Palm Beach Elementary
Royal Palm School
S. D. Spady Elementary
Sandpiper Shores Elementary
Santaluces Community High
Seminole Ridge Community High
Seminole Trails Elementary
South Grade Elementary
South Intensive Transition
South Olive Elementary
Spanish River Community High
Starlight Cove Elementary
Suncoast High
Sunrise Park Elementary
Sunset Palms Elementary
The Conservatory School
Timber Trace Elementary
Tradewinds Middle
Turning Points Academy
U. B. Kinsey/Palmview Elementary
Verde Elementary
Village Academy on the Art & Sara Jo Kobacker Campus
Washington Elementary
Waters Edge Elementary
Watson B. Duncan Middle
Wellington Community High
Wellington Elementary
Wellington Landings Middle
West Boca Raton Community High
West Gate Elementary
West Riviera Elementary
West Transition Elementary (Crossroads)
Western Pines Middle
Westward Elementary
Whispering Pines Elementary
William T. Dwyer High
Woodlands Middle
Wynnebrook Elementary
Agency/School Zip Code
*
ZIP Code
Homeroom Teacher
If applicable
Student Initials
*
Student Grade Level
*
Pre-Kindergarten
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Other
Gender
*
Male
Female
Other
Student Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Hispanic or Latino
Multiracial
Student Status
*
Homeless
Not Homeless
If Homeless, Please Select one of the Following Drop Downs
*
Living in Shelter
Living With Family Member
Living in Motel/Hotel
Living in vehicle/car
other(Need to specify and fix)
Reason for Student Referral
*
Emergency/Walk-in
Create Care Package
Create Care Package
Please tell us about the student and the background for the request.
This will help us to serve the students needs and understand the student's situation.
Student Clothing Style Preferences
*
Is the student a girly-girl? A tomboy? Love the cowboy look? Let us know!
Clothing Items Needed
Please work with the family/caregiver to get appropriate sizes and style preferences.
Uniform Color(s)
Uniforms Sizes
Size Type
*
Choose an Option
Toddler
Youth
Juniors / Teens
Women
Men
Toddler Pants Sizes (unisex)
Choose Size
Toddler: 2T
Toddler: 3T
Toddler: 4T
Toddler Top Size (unisex)
Choose Size
Toddler: 2T
Toddler: 3T
Toddler: 4T
Youth Pants Sizes (unisex)
Choose Size
Youth: 4T - XS
Youth: 5T - XS
Youth: 4 - XS
Youth: 5 - XS
Youth: 6 - Small
Youth: 6X - Small
Youth: 7 - Small
Youth: 8 -Sm/Medium
Youth: XSmall 4-5
Youth: Small 6-8
Youth: Medium 10-12
Youth: Large 14-16
Youth: XLarge 18-20
Youth Top Sizes (unisex)
Choose Size
Youth: 4T - XS
Youth: 5T - XS
Youth: 4 - XS
Youth: 5 - XS
Youth: 6 - Small
Youth: 6X - Small
Youth: 7 - Small
Youth: 8 -Sm/Medium
Youth: XSmall 4-5
Youth: Small 6-8
Youth: Medium 10-12
Youth: Large 14-16
Youth: XLarge 18-20
Junior Pants Sizes (Teen Girls only)
Choose Size
Junior: 0 - 1 XS
Junior: 3 - 5 S
Junior: 7 - 9 M
Junior: 11 - 13 L
Junior Top Sizes (Teen Girls only)
Choose Size
Junior: 0 - 1 XS
Junior: 3 - 5 S
Junior: 7 - 9 M
Junior: 11 - 13 L
Women Pants Sizes
Choose Size
Women's Pants 0
Women's Pants 2
Women's Pants 4
Women's Pants: 6
Women's Pants: 8
Women's Pants: 10
Women's Pants: 12
Women's Pants: 14
Women's Pants: 16
Women's Pants: 18
Women's Pants: 20
Women's Pants: 22
Women's: 24
Women Top Sizes
Choose Size
Women: 4-5 XS
Women: 6-8 S
Women: 10-12 M
Women: 14-16 L
Women: 18-20 XL
Women: 22-24 XXL
Women: 26-28 XXXL
Bras (Females Only)
Mens Pants Sizes Waist (includes Young Men)
Choose Size
Men’s Pants: 28
Men’s Pants: 29
Men's Pants: 30
Men's Pants: 31
Men's Pants: 32
Men's Pants: 33
Men's Pants: 34
Men's Pants: 35
Men's Pants: 36
Men's Pants: 37
Men's Pants: 38
Men's Pants: 39
Men's Pants: 40
Men's Pants: 41
Men's Pants: 42
Men's Pants: 43
Men's Pants: 44
Men's Pants: 45
Men's Pants: 46
Men's Pants: 47
Men's Pants: 48
Men's Pants: 49
Men's Pants: 50
Mens Pants Sizes Length (includes Young Men)
Choose Size
Men’s Pants: 28
Men’s Pants: 29
Men's Pants: 30
Men's Pants: 31
Men's Pants: 32
Men's Pants: 33
Men's Pants: 34
Men's Pants: 35
Men's Pants: 36
Men's Pants: 37
Men's Pants: 38
Men's Pants: 39
Men's Pants: 40
Men's Pants: 41
Men's Pants: 42
Men's Pants: 43
Men's Pants: 44
Men's Pants: 45
Men's Pants: 46
Men's Pants: 47
Men's Pants: 48
Men's Pants: 49
Men's Pants: 50
Mens Top Sizes (includes Young Men)
Choose Size
Men'Shirts:14-14.5 Sm
Men Shirts:15–15.5 Med
Men Shirts:16 -16.5 Lg
Men Shirts:17-17.5 XL
Men Shirts:18 -18.5 2XL
Men Shirts:19 -19.5 3XL
Underwear (Male or Female)
Choose Size
YES
NO
Size determined based on previous selections.
Socks (Male or Female)
YES
NO
Size determined based on previous selections.
Shoes (Male or Female)
Choose Size
Shoes: Toddler 05
Shoes: Toddler 06
Shoes: Toddler 07
Shoes: Toddler 08
Shoes: Toddler 09
Shoes: Toddler 10
Shoes: Children 01
Shoes: Children 01.5
Shoes: Children 02
Shoes: Children 02.5
Shoes: Children 03
Shoes: Children 03.5
Shoes: Children 04
Shoes: Children 04.5
Shoes: Children 05
Shoes: Children 05.5
Shoes: Children 06
Shoes: Children 10
Shoes: Children 11
Shoes: Children 12
Shoes: Children 13
Shoes: Men 07
Shoes: Men 07.5
Shoes: Men 08
Shoes: Men 08.5
Shoes: Men 09
Shoes: Men 09.5
Shoes: Men 10
Shoes: Men 10.5
Shoes: Men 11
Shoes: Men 11.5
Shoes: Men 12
Shoes: Men 12.5
Shoes: Men 13
Shoes: Men 13.5
Shoes: Men 14
Shoes: Women 06
Shoes: Women 06.5
Shoes: Women 07
Shoes: Women 07.5
Shoes: Women 08
Shoes: Women 08.5
Shoes: Women 09
Shoes: Women 09.5
Shoes: Women 10
Shoes: Women 10.5
Shoes: Women 11
Uniform Bottoms
Select All
Bottom: Black
Bottom: Khaki
Bottom: Navy Blue
Select multiple
Uniform Tops
Select All
Top: Baby Blue
Top: Forest Green
Top: Goldenrod Yellow
Top: Maroon
Top: Navy Blue
Top: Red
Top: Royal Blue
Top: White
Top: Black
Top: Purple
Select 1-3 color choices
Hygiene Items
Hygiene Kits
Body Kit - Soap, Shampoo/Conditioner (Lotion, when available)
Dental Kit - Toothbrush, Toothpaste (Floss, when available)
None
Miscellaneous Hygiene Items
Body Lotion
Deodorant
Soap
Shampoo/Conditioner
Toothbrush/Toothpaste
Floss
None
Individual items if needed
Feminine Hygiene
Pads Only
Tampons Only
Both Pads/Tampons
None
Verification
Verification (The GCP is designed to help students from low income families who qualify for free or reduced lunch. We ask that you check this box as verification that you are requesting items for a student in need whom, to the best of your knowledge, is unable to obtain necessary items needed for success in school)
*
By checking this box, you verify that you are requesting items for a student in need
Family Outreach (In an effort to de-stigmatize situational poverty, The GCP asks that you contact the caregiver of the student in need to make them aware of our organization and the referral you have completed for their child)
*
By checking this box, you affirm that you will attempt to contact the student's family
Comments
This field is for validation purposes and should be left unchanged.
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