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SCE 5th Grade Community Agency Opt-Out Form
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Dear WSD Family,

Throughout the duration of the academic year, the Wentzville School District partners with community agencies that specialize in providing students, families, and educators with preventative education.  Agency presenters are credentialed, coordinated throughout the District, and under the supervision of building administrators.  Presentation topics are targeted toward specific grade levels.  All students will participate in each program, unless you choose to opt your child out of the lesson(s).  The program that is scheduled for 5th grade is listed below:

Program: Signs of Suicide (SOS)
Topic: Suicide Prevention*
Community Agency: CHADS Coalition

This program equips students with tools to identify symptoms of anxiety and depression, along with warning signs of suicide.  The acronym "ACT" (acknowledge, care, tell) is shared, as are coping skills for dealing with difficult situations.  This presentation includes a brief student survey to assess understanding and/or needs regarding mental health concerns.

*Pursuant to Section 170.048 RSMo., school districts are required to have in place a policy that addresses and includes, but is not limited to, the following:
1) Strategies that can help identify students who are at possible risk of suicide;
2) Strategies and protocols for helping students at possible risk of suicide; and
3) Protocols for responding to a suicide death.

The Wentzville School District addresses this state statute through Policy 2785.


Student's First Name: *
Student's Last Name:  *
Teacher's Last Name: *
A copy of your responses will be emailed to the address you provided.
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