Alternate Learning Center

Current Service Provider List

2023-2024 School Year

Students Name:
	
Parent/Guardian Name(s):
	
Home Phone:
	
Cell Phone:
	
Email :

Mental Health Agency:
	
Diagnosis (all):
	
Current medications:
	
Counselor/Case Manager:	Phone:
	
Dr./Psychiatrist:	Phone:

Probation/Parole Officer:	Phone:
	
Board of DD Worker:	Phone:
	
LCCS Worker:
	
Other Agency Involvement (List)	Phone Number(s):