SPARK - Referral Form
Nelson Mandela Public School - Supporting Student Success
The SPARK program is an exciting and influential program offered to the students at Nelson Mandela P.S. to support student learning & achievement, mental health and overall well-being. SPARK focuses on using physical activity to support brain function and improving learning in the classroom.
Referral Form: Please fill out below and submit
Student Name:________________________
Referring Teacher Name:________________________________________
Please check-off following SPARK criteria applicable to referred student
_____ difficulties maintaining focus and attention in class
_____ hyperactive characteristics in class
_____ consistent behavioral issues in class and on playground
_____ difficulties in social interactions amongst peers
_____ consistent display of boredom, lack of motivation and effort in class
Additional information applicable to student
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