Bell High School

Referral Forms

All forms are Word documents that will download to your computer when you click on them.

These forms are offered here in two formats.
If you want to print the form and fill it out by hand - click on Version 1.
If you would prefer a digital form which you can fill out on your computer click Version 2.
Version 2 forms may be printed after being filled out or e-mailed to the proper person or office.

Confidential PSA Referral
Version 1
Version 2
Send referrals for all Limited English Profficient (LEP) Students to Ofelia Ryan - ofelia.ryan@lausd.net
Send referrals for all other students to Rosalba Gonzalez - ruribe@lausd.net

Confidential Referral to Psychiatric Social Worker
Version 1
Version 2
These forms should be returned via e-mail - guadalupe.alvarez@lausd.net or by using Jinger Alvarez's mailbox in the Main Office or her tray in the Counseling office in a SEALED envelope indicating the student’s name, grade and track.

Student Referral to Dean's Office
Version 1
Version 2

IMPACT Staff Member Referral
Version 1
Version 2
Deliver filled out forms to the Impact Office or send to the Impact Coordinator at tlp2695@lausd.net

IMPACT Self Referral
Version 1
Version 2
Deliver filled out forms to the Impact Office or send to the Impact Coordinator at tlp2695@lausd.net