Monroe County, MI · Monroe County
ESS Referral Application
The ESS Referral Application collects youth, caregiver, school, and referral-source information for referring an eligible middle school student to ESS.
At a glance
- Issued by
- City of Monroe County · Monroe County, Monroe County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- co.monroe.mi.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This application gathers information about a youth’s age, school, caregiver contacts, and circumstances relevant to ESS eligibility. The youth must be at least 11 years old and a middle school student, and must meet at least two listed criteria. It also includes sections for the school to identify concerns and for ESS staff to record information based on parent input.
Who needs it
A school, CMH, probation, or other referral source can complete this application for a middle school student who may meet ESS criteria.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This application is completed without a notary; no notarized attachment or sworn step is listed, and the referral source provides a name and date.
How to submit this form
- 1
Download the Application
Download the ESS Referral Application for Monroe County.
- 2
Complete the Referral Details
Fill in the youth, school, caregiver, and referral-source information requested on the form.
- 3
Gather Any Relevant Information
If the youth has an IEP, the form asks for a copy. Complete the school and ESS sections as directed.
- 4
Submit to the County
Submit the completed application to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What is the ESS Referral Application for?
- It gathers information about a youth, caregivers, school, referral source, and areas of concern for an ESS referral. The form also includes sections for school input and ESS staff notes.
- Who may be referred using this application?
- The form is for a middle school student who is at least 11 years old and meets at least two of the listed criteria. It identifies schools, CMH, probation, and other sources as referral sources.
- Do I need a notary for the ESS Referral Application?
- No. The application has no notary block and lists no notarized attachment or sworn step; the referral source provides a name and date.
- How do I submit the ESS Referral Application?
- The form does not provide submission instructions. Submit it to the county department named on the form, and check the county website for current contact details.