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WE ARE HERE TO HELP YOU
Dear Student,

If you are experiencing a problem and would like someone from school to help you, please complete the following questions as best as possible.  We have multiple staff members that can help you with any situation you may be experiencing. (Homework, family problems, Edmentum, Calvert, logging on to virtual learning, bullying, career options, college, busing, attendance, etc.)

******PLEASE REMEMBER THAT IF YOU'RE HAVING AN EMERGENCY, CALL 911******

This form will be checked on a daily basis, but give us 24-hours (reflects normal school hours of operation) to get back to you.

Your school also wants to remind you that we will practice confidentiality.  That means that everything you discuss with us is confidential unless it's disclosed that a student is in danger of any kind by hurting himself/herself, by someone else hurting them in any way, or if they share knowledge of someone else hurting others.

Note:  Below are resources available should you find yourself or someone else in a situation where immediate mental health services are needed.

NATIONAL SUICIDE PREVENTION HOTLINE 1-800-273-8255
CENTRAL CRISIS & SUICIDE PREVENTION Text HOME to 741741
SAGINAW COUNTY CRISIS HOTLINE  (989) 792-9732 or (800) 233-0022
OK2SAY (855)565-2729 or TEXT 652729
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FIRST NAME (student) *
LAST NAME (student) *
STUDENT GRADE LEVEL *
How can we get a hold of you? If you need help, please share with us at least one way to contact you. If you don't fill this part out, we may not be able to reach you.
Please fill out as many contacts as you can.
Email
Phone Number (no dashes or parentheses)
Address (number and street)
Please check all  that apply. *
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Please give us a brief description of the issue you're are having. *
If there is a staff member that you would like to talk to, please enter their name below.  
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