Describe your referral process. Makeform turns it into a student of concern form for reporting observable changes, supports already tried, urgency, and the team that should respond.
Route referrals to email, Slack, Google Sheets, and Zapier.
Sample prompts for the builder
Choose a starting point, tailor it to your school, or send it into the builder. Each example shows a practical referral structure.
Prompt ready4 formats
Audience
Teachers referring a student whose classroom performance has changed
Format
Structured referral with subject, timeline, and attempted supports
Prompt size
468 chars
Brief qualitySends to builder
Example form structure
Structured referral with subject, timeline, and attempted supports
Prompt exampleEditable in builder
Referring staff member and contact
Short answerFirst ask
2
Student, grade, and subjects affected
Short answer
3
What change did you directly observe?
Long answer
4
Supports tried and student response
Long answer
5
Requested next step and urgency
Multiple choice
Suggested routing tags
Suggested
Routine review
Priority follow-up
Assigned to support team
Ask staff to describe what they directly observed, when it began, and how often it happens. Specific observations give the support team a clearer starting point than labels or conclusions.
Step 1
Observe
record specific changes, dates, settings, and frequency
Step 2
Refer
submit context, strengths, and supports already attempted
Step 3
Triage
route by urgency and concern type to the right team
Step 4
Follow up
assign ownership, document action, and close the loop
A clearer first signal
Turn a worried message into an actionable referral.
A student of concern form gives every staff member the same path for raising a concern. The team receives observable evidence, context, urgency, and prior supports together instead of reconstructing the story from email threads.
Specific observations, not labels
Prompts for dates, settings, frequency, and directly observed actions help staff describe what changed without guessing at causes. Reviewers can distinguish a single event from an emerging pattern.
Urgency branches that guide staff
Conditional questions separate routine review, same-day follow-up, and immediate danger. An immediate-danger choice displays the school's direct response instructions so staff do not wait on a form inbox.
One handoff the team can work
Concern category, grade, location, and requested support can drive routing. The team starts with a consistent referral, and the referrer knows who owns follow-up.
Designed for school contexts
One referral path, several kinds of concern.
Start with a shared intake and reveal focused follow-up questions only when they apply. Staff get a shorter experience, and reviewers still receive the detail needed for the selected concern.
Academic change
Document missed work, declining performance, difficulty beginning tasks, affected subjects, and changes from the student's usual pattern. Ask for work samples and strategies already tried rather than relying on a broad statement that the student is struggling.
Behavior and relationships
Capture what happened, what preceded it, where it occurs, frequency, duration, impact, and the student's response to support. Separate repeated patterns from a disciplinary incident that belongs in another workflow.
Wellbeing and engagement
Record changes in participation, attendance, peer connection, presentation, or statements of distress in careful, factual language. Include whether a trusted adult is with the student and when follow-up is requested.
Attendance and access barriers
Note absence or lateness patterns, transportation or technology barriers, schedule factors, and family contact already attempted. Routing can connect the referral with the staff member responsible for the relevant support.
Build the referral workflow
From staff observation to an owned next step.
Generate the core student of concern form, then adapt the wording, routing, and response expectations to the roles and procedures at your school.
Tell Makeform which staff may refer, the concern categories your team reviews, required student identifiers, and how you define routine, priority, and immediate response. Include the direct phone number or in-person procedure staff must use for immediate danger.
02
Edit fields for observable evidence
Replace vague prompts with questions about what staff saw or heard, dates, frequency, location, impact, and change from baseline. Add conditional sections for academic, behavior, attendance, or wellbeing concerns so irrelevant questions stay hidden.
03
Set routing and confirmation messages
Send new referrals to the designated team mailbox or workflow, using category and urgency to notify the right reviewer. Give the referrer a confirmation that explains expected review timing and repeats the direct route for a situation that becomes urgent.
04
Test, publish, and review the process
Submit fictional routine, priority, and immediate-danger test cases. Confirm that conditional fields appear, the correct people receive each route, attachments arrive, and the confirmation text is clear before sharing the form with staff.
Referral form vs email vs incident report
Choose the workflow that matches the concern.
A student concern referral is meant to connect observations across time and request coordinated support. It should sit alongside, not replace, your school's immediate response and formal incident-reporting procedures.
Approach
What it captures
Best fit
ApproachEmail or hallway conversation
What it capturesA quick narrative that may omit dates, prior supports, urgency, or the requested next step.
Best fitUseful for coordination after a referral exists, but difficult to triage consistently as the intake itself.
ApproachBehavior or safety incident report
What it capturesA defined event, people involved, location, witnesses, immediate actions, and event-specific follow-up.
Best fitUse when school procedure requires documenting a particular incident rather than a broader pattern of concern.
Approach
Student of concern form
What it capturesObserved changes across dates or settings, strengths, interventions attempted, urgency, and support requested.
Best fitBest for bringing a developing academic, behavioral, attendance, or wellbeing pattern to a support team.
Field guide
What a student of concern form should include.
The strongest referral form is brief enough for busy staff and structured enough for meaningful triage. These six sections establish identity, evidence, context, urgency, and a clear request without asking the referrer to reach conclusions beyond their role.
Student and referrer
Match the concern to the right student and contact.
Start with the minimum identifiers your school uses to match internal records, plus the referring staff member's role and contact details. A reviewer may need clarification quickly, so the referral source should never be buried in narrative text.
Student name, school identifier, grade, and homeroom or advisor.
Referrer's name, role, email, and relationship to the student.
Date submitted and preferred way to follow up with the referrer.
Observable concern
Describe changes a reviewer can understand.
Ask for concrete words, actions, work patterns, attendance changes, or interactions. Date and frequency fields help establish whether the report concerns one observation, a recent shift, or a recurring pattern. A prompt for change from the student's usual presentation adds important context.
Primary concern category with an optional secondary category.
What staff directly saw, heard, or documented, using specific examples.
First noticed date, most recent date, frequency, duration, and settings.
Impact and evidence
Show where the concern affects participation.
Ask about impact on learning, attendance, peer connection, activities, or routines. Structured choices make patterns scannable, while an open response preserves nuance. Optional uploads can carry work samples or observation notes.
Classes, locations, activities, or times of day where the pattern appears.
Effect on participation, task completion, relationships, or access to learning.
Optional work samples, attendance summaries, or observation records.
Strengths and student voice
Keep the referral grounded in the whole student.
Ask about interests, trusted relationships, successful settings, and strategies that help. If the student shared information, let staff record the student's words accurately without interpreting them.
Strengths, interests, successful classes, and positive peer or adult connections.
What the student says would help, recorded in their own words when possible.
Conditions or supports associated with better engagement.
Supports already attempted
Give the team a usable starting point.
List each strategy, the date or period used, how consistently it was applied, and what changed. This prevents the support team from recommending the same step without knowing it has already been tried, and it distinguishes a brief attempt from a sustained intervention.
Classroom adjustments, check-ins, reteaching, schedule changes, or outreach attempted.
Dates, frequency, responsible staff member, and student response for each support.
Family or caregiver contact completed and any next step already agreed, when applicable.
Urgency and requested action
Make timing and ownership explicit.
Offer urgency choices with school-defined descriptions, then ask what the referrer needs from the team. Immediate-danger language should direct staff to the school's live response route and make clear that submitting the form is not enough. Routine submissions still need an owner and expected review window.
Routine, priority, or immediate response options defined in plain language.
Whether the student is currently supervised and who has been notified.
Requested consultation, observation, meeting, resource, or team review.
Related school tools
Connect concern intake with the rest of student support.
Use separate forms when a specific incident, progress update, student perspective, or family meeting needs its own structured workflow.
Practical answers for school leaders, teachers, counselors, and support teams creating a consistent referral path.
What is a student of concern form?
A student of concern form is an internal referral used by school staff to report an observed academic, behavioral, attendance, engagement, or wellbeing concern to a designated support team. It typically identifies the student and referrer, describes specific observations and timing, lists supports already attempted, notes strengths and relevant context, indicates urgency, and states what help is requested. The form creates a consistent starting point for review; your school decides the follow-up procedure and responsible roles.
What should staff write in the concern description?
Ask staff to record what they directly saw, heard, or documented, including dates, approximate frequency, setting, duration, and impact. A statement such as the student put their head down and did not begin work in four morning classes this week is more actionable than a label such as unmotivated. Staff can also note what changed from the student's usual pattern and quote information the student voluntarily shared. Avoid prompts that ask the referrer to diagnose a cause.
How should the form handle an urgent safety concern?
The form should display your school's direct emergency or immediate-response instructions whenever staff select an immediate-danger option. Tell staff whom to call or where to go, whether to remain with the student, and that they should not wait for a form submission to be read. Configure the actual wording with your school leaders and local procedures. Test this branch before launch, and keep routine or priority referral routes separate from the live response path.
Can the form cover academic, behavior, attendance, and wellbeing concerns?
Yes. Begin with a concern-category choice and use conditional logic to reveal the relevant section. An academic branch might ask about affected subjects and work samples; a behavior branch might ask about setting, antecedent context, frequency, and impact; attendance can capture patterns and access barriers; wellbeing can record observed changes and requested timing. Shared questions about strengths, attempted supports, urgency, and requested action can remain at the end for everyone.
Is the student of concern form generator free?
Yes. Makeform supports unlimited free forms and responses, so a school can generate, edit, publish, and use its concern referral without a response cap. The paid tier removes the Makeform badge. You can revise the generated structure before sharing it, and you should test routing, conditional sections, confirmation messages, and immediate-response instructions with fictional submissions before staff begin using the form.
Who should receive submitted concern forms?
Route submissions only to the roles your school designates for student support intake, such as a student assistance team, grade-level support lead, counselor, administrator, or attendance team. Concern category, grade, location, and urgency can determine the route. Avoid broad distribution lists when the details are sensitive. Name a primary owner, a backup, an expected review cadence, and a process for telling the referrer that the referral was received and assigned.
Should the form include supports already attempted?
Yes. Ask what was tried, when and how often it was used, who implemented it, and what the student response was. Examples might include a check-in, seating change, assignment chunking, reteaching, schedule adjustment, attendance outreach, or family contact. This gives the team a useful baseline and reduces repeated recommendations. Also ask about strategies that work, strengths, interests, trusted adults, and settings where the student is successful.
How do we introduce the form to school staff?
Pair the link with a short protocol: which observations belong on the form, which incidents use another report, what requires immediate contact, who reviews submissions, and when staff can expect acknowledgment. Demonstrate a factual example and show the urgency branch. After staff have used the workflow, remove fields that do not inform decisions.
Give every concern a clear route to support.
Generate your student of concern form and turn observations into an owned next step.
Unlimited free forms and responsesEditable concern and urgency branchesClear routing and follow-up fields
