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Care & Concern Form
DO NOT fill out this form for any suspected abuse or self harm, crisis situation, or any matter that needs immediate attention. Dial 0 for intimidate assistance from your Counselor and Administrator.
DO fill out this form to alert Counseling of developing student concerns.
Some examples of why you would complete this form:
- Academic performance has declined
- A student's demeanor has changed
- A student has been absent more often
-A student seems to have a lack of motivation in class/engagement level has changed
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Staff member referring the student
Student Name (first and last)
Student Grade Level
Briefly describe concern and any interventions you have already tried:
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This form was created inside of Jefferson County Public Schools.