Staff Referral Form – Parent Resource Center

Staff Referrals Forms

Madera Unified School District Believes in parents as true partners in the education of our students. We believe that in collaboration with parents, families, student champions and invested community stakeholders our district is able to deliver an unparalleled educational journey that is intellectually, socially and personally transformative for our students.

Staff Referral Forms

Conversational Form (#3)

First & Last Name

PRC Assistant Support for MUSD

Please help us identify the Parent's needs by completing this Google Form. One of our PRC Assistants will reach out to the family within 24 hours of you submitting this Form. If the Parent would like to talk to someone from PRC, please refer them to the Call Center at 559-416-5879 M-F 8 am-7 pm. If you would like to contact us, contact Erika Chaidez at erikachaidez@maderausd.org

Child Care Request Form (FOR MUSD STAFF)

Please use this form to request a Child Care Provider (CCP) for your Department or School Site. This request should be submitted 2-4 weeks before your event date so we can have more time to secure a CCP for your request. The CSPRC Department will assist with assigning 1-2 CCPs, notifying them of the location, date, time, and who to contact upon arrival. They will also have materials and games needed to support the Children in the program. Your Site/Department is responsible for providing the CCP/s with a timesheet, and you will be covering those expenses unless you have made other arrangements with the Director of CSPRC. Once we have made arrangements for your request, Yvonne Sandoval will contact you Via Email or telephone with the name/s of the CCP. If you need to contact us in regards to this matter, please call Yvonne Sandoval at 559-416-5909 or Erika Chaidez at 559-416-5858 ext.11164

REQUEST FOR INTERNET ESSENCIALS PROMO CODE/HOTSPOT(FOR MUSD STAFF TO SUBMIT)

The Parent Resource Center (PRC) and the Department of Technology (IT) are in collaboration to support our Families with Free Internet; this form will be used for MUSD Staff to submit a request for a Promo Code for Free Internet or if the Parent for whatever circumstances does not qualify for Free Internet, IT will determine if they are eligible for a Hot Spot. After submitting the form, PRC Staff will contact the family and ask them questions regarding their situation. After that, they will determine if the family qualifies for a promo code; if they Do Qualify, they will be emailed an Internet Essential Letter with the Promo Code specially assigned to them with instructions on how to apply in English and Spanish. PRC Staff will add them to the Hot Spot Request List if they do not qualify for a Promo Code. IT will then determine if the family qualifies for a Hotspot or Not. PRC Staff will then notify the family of the outcome. If they Do Qualify for a Hot Spot, IT will deliver the device to the Prices Building, and the Parent will receive a phone call from PRC Staff notifying them when it's ready for pick-up. If the family has transportation issues, please select the method in the section below. Just so you know, the turnaround time for this process can take 1-2 days, but at most that. If you need to contact anyone in regards to this matter, please call the Call Center at 559-416-5878

Newcomer Families Referral to PRC

For any newcomer families coming into the district, please refer them to the PRC department so staff can connect these families to district and community resources.

Parent Project & Loving Solutions Referral

We are excited to share that we now accept referrals for our evidence-based and community-driven in-person parenting program: Parent Project, and Loving Solutions. The program has evidence of reducing family conflict, juvenile crime, recidivism, and high-risk behavior while increasing School performance, home/school communication, and Parental supervision. Parent Project is for parents with children in 6th-12th grade and is an intervention-based program. Loving Solutions is for parents with children in K-5th grade and is a prevention-based program. We kindly request your assistance in promoting these classes and referring families who could benefit from them. Once referrals are made, we will make friendly phone calls to those referred parents to encourage them to attend and provide them with information about start dates, times, and locations for the next cohort. Please let your families know about the follow-up phone call from PRC. We appreciate your dedication to our students and their families. Together, we can create a stronger, more supportive community.

Name of the Student & ID #

Referred by: First & Last Name

Parent Full Name & Telephone Number

Select School Site

Department

What can we assist the Parent with?

MUSD Staff First & Last Name

MUSD Staff Contact Phone Number

Referred by Email

Referred by Phone Number

Parent Name

Parent Contact Number

Preferred family's language

Was the family made aware that they will be contacted by our PRC department?

MUSD STAFF: Please list ALL Students you are referring (First Name, Last Name and Student ID)

COMMUNITY AGENCIES: Please list ALL Parent Names and Phone Numbers*

Comments or helpful information about the family

Select the Reason/s that you are requesting Free Internet/Hotspot

If you know that the Family has transportation issues, please select what delivery method you would like to arrange. Select one option

If your student is enrolled in any of the following programs: Independent Studies (ISP), In-Home Hospital, Homeless Program, or Furman Elementary/High School, those school sites or departments have their own devices for home and school use. Students enrolled in these programs do not need to go through the approval process. Please refer to them for assistance instead of requesting a device.

Name of Workshop

Location (School Site or Department Building) and Child Care Room number, CCP will be reporting to.

Date & Time of the Event (please allow 30-15 min of prep time before and 15 min of cleaning time after program is over)

Please upload a flyer if you have one available

Choose File

Estimated Number of Parents

How many Child Care Providers are you requesting?

Is this a one-time event or is it for multiple days/weeks event?

If this is a multiple day/week event, how many sessions would you need support? Please add dates and times below.

Staff Referrals Forms

Staff Referral Forms

PRC Assistant Support for MUSD

Child Care Request Form (FOR MUSD STAFF)

REQUEST FOR INTERNET ESSENCIALS PROMO CODE/HOTSPOT(FOR MUSD STAFF TO SUBMIT)

Newcomer Families Referral to PRC

Parent Project & Loving Solutions Referral

Resources

General

Contact

Office

Department of Community Services and Parent Resource Centers