Henry D. Perry Education Center Procedure for Referring Schools Please use the form below. Referral Information Please complete the following information Name of person making the referral(required) Phone(required) Email address(required) Relationship to the student being referred(required) Student Parent Administrator School Counselor ESE Specialist Student Information Student's First Name(required) Student's Last Name(required) Student's Identification Number(required) Date of Birth(required) Grade(required) Current School(required) Campus Referral Information What HDPEC location are you interested in attending? Main Campus Off Campus Choose one of the following locations Off Campus Location Site Southwestern Lake Central North Broward Park Lakes Annex Riverside Commercial North Sailboat Bend South Central South Eastern Sessions AM (7AM - 12PM) PM (12PM - 5PM) Evening (4PM - 9PM) Parent Contact Information Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian's Phone Parent/Guardian's Email address(required) Parent/Guardian's Address 1(required) Parent/Guardian's City(required) Parent/Guardian's State(required) Reason for Referral Overage for grade Not on track to graduate Poor attendance Seelect all that apply Are you human?(required) This field should be left blank Send Please wait...
