Coughlin Student Assistance Program (SAP) Initial Referral Form 2018-19
*Always err on the side of caution. If you feel this is an emergency situation, dial 911, contact your local authorities, call the Helpline at 211 or call the Childline at 800-932-0313. The Childline is available 24 hours to receive reports of suspected child abuse. SAP referrals are viewed during school hours only. For the 2018-19 school year, the SAP Team is accepting referrals up until and including , May 23rd, 2019.

The Student Assistance Program is a state-mandated K-12 program designed to assist school personnel in identifying issues including alcohol, tobacco, other drugs, and mental health issues which pose a barrier to a student's success.

Anyone may make a SAP referral. Referrals may be made anonymously except in the case of teachers or staff. It is expected that teachers and staff identify themselves when making a referral when working in their professional capacity. This information is confidential and not shared with the student.

Name
All employees of Wilkes-Barre Area School District must provide their name
Your answer
Student's Last Name *
Your answer
Student's First Name *
Your answer
Grade of student being referred *
What is your role? *
Have you contacted the parent of the student you are referring?
What type of contact have you made?
Tell us more about the contact you made and the results of that contact.
Your answer
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