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 <br /> <br />CRITICAL INCIDENT REVIEW COMMITTEE (C.I.R.C) <br />STUDENT SUMMARY PROFILE <br />(Reference: Procedure PR.528.SCO) <br /> <br /> <br /> <br />DEMOGRAPHIC INFORMATION <br /> <br />Name: <br />      <br />D.O.B: <br />      <br /> <br /> <br /> <br /> <br />School: <br />      <br />Grade: <br />      <br /> <br /> <br /> <br /> <br /> <br />Present Program: <br />      <br /> <br /> <br /> <br />The personal information on this form is collected under the authority of the Education Act and will only be used to record a summary of the student’s involvement in critical incidents <br /> and Critical Review Committee’s recommendations. This information is confidential and access should be limited to only those employees who require the information in the conduct of <br /> their duties and the individual to whom the information relate, and the parent(s)/guardian(s) of a student who is under eighteen years of age. Questions regarding the collection of <br /> this information should be directed to the school principal. <br /> <br /> <br />SCHOOLS ATTENDED <br /> <br /> <br /> <br /> <br />School / Board <br /> <br />Date <br /> <br /> <br />      <br /> <br />      <br /> <br /> <br />      <br /> <br />      <br /> <br /> <br />      <br /> <br />      <br /> <br /> <br />      <br /> <br />      <br /> <br /> <br />      <br /> <br />      <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />ACADEMIC PROFILE <br /> <br /> <br /> <br /> <br />Academic Performance (e.g., number of credits, marks, areas of strength / weakness) <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br /> <br /> <br />Educational Assessment <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br /> <br /> <br />Psychological Involvement / Assessment <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br /> <br /> <br />Social Work Involvement / Assessment <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br /> <br /> <br />BACKGROUND INFORMATION <br /> <br />(e.g., family, medical, community, schools attended, extracurricular involvement etc.) <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />      <br /> <br />