Referral Form
School Police/M-DCPS 

Information on person making referral

Dade Schools Police Referral District

Information on Client/Family being Referred

Client's Information


Parent/Guardian Information

Reason for Referral/Notes from Referral Agency

I. What services does the family need? (Select all that apply) *
II. What services does your school/organization need? (Select all that apply)
III. Did the client and/or family agree to receive faith-based services? *
IV. Is the client employed? *
For any questions of the program please call Ret. Comdr. Raul Correa (305)209-5828 or Roland Gonzalez (786)286-4814