Student Success Story Form Student InformationStudent Name (optional)* Student Gender/Pronoun* Student's School* Student's Site Coordinator* Affiliate* Auburn Benton-Franklin Federal Way Kent Lakewood Peninsula Puyallup Renton Seattle Spokane County Tacoma Whatcom County Student Case PlanWhat were the student’s barriers to success? Why was the student referred to their school’s site coordinator?*Risk factors and any pertinent history that would help readers understand the struggles this student has faced.What services were the student connected to thanks to their site coordinator?*Please provide service provider names (whether personal or organizational) whenever possible.Student ProgressWhat academic progress has the student made since being connected to those services and working with the site coordinator?*What non-academic (social/emotional) progress has the student made since being connected to those services and working with the site coordinator?*In what way(s) did the site coordinator impact the student and/or their family? How has the student improved since working with the site coordinator?**If possible, please include a direct quote from the student, site coordinator, teacher, principal, parent, or other individual who can speak to the impact CIS has had on the student.What are the student’s plans/goals for the future?*File UploadIf you are including the student's name or a picture, please upload the permission form signed by a parent or guardian.Pictures and name(s) are 100% optional. If you include one or both on this form, a permission slip/release is required before use. Drop files here or Select files Max. file size: 5 MB, Max. files: 5.