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                         Dunmore High School (9-12)                                      SAP Referral Form 2025-2026
The Student Assistance Program is a state mandated program to identify and assist students.  Students are referred regarding problem behaviors such as a decline in grades, suspected drug use or behaviors that inhibit learning.  Anyone may make a referral.  Referrals can be made anonymously except in the case of teachers or staff.  It is expected in their professional capacity that teachers and staff identify themselves when making a referral.  This information is confidential and not shared with the student.
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IMPORTANT **PLEASE READ**
Please note that if you have concerns regarding the immediate welfare of a child during the school day, such as suicidal ideations, self harm, or possession of weapons or drugs, discontinue this process and immediately contact a counselor or administrator.  For similar concerns outside of school hours, please call 911.
Student Name *
Reason for referral *
Your name
Student grade *
Required
Your role *
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