Student Self COST Referral
Complete this form to request a check-in with a counselor/mental health support staff.
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Attention Student, 

Before filling this form out, please read the following:

IF THIS IS AN EMERGENCY, DO NOT fill out this request. 

Please ask a COST member or trusted adult in person for an immediate check in. 

If you are experiencing an emergency AFTER SCHOOL HOURS, please call 911. If you or a loved one are experiencing a mental health crisis, please contact the Los Angeles County Access and Crisis Line at 1 (800) 854-7771 or text "LA" to 741-741.

You can also call or text the Suicide & Crisis Lifeline at 988. 

IF THIS NOT AN EMERGENCY, proceed to filling out this request. Someone from our team will reach out to you within a week during school hours only. Please wait to be contact by our team before submitting a new request.

You can also check in with your Advisory teacher if you just need someone to talk to or have general questions about school. 

Thank you!

Please note: During the check-in we may need to take additional steps if we believe there are safety concerns for you or others. This may include the following:

  • Student is in immediate and imminent danger.
  • Another student is in immediate and imminent danger.
  • The student or someone he/she/they knows is being abused.
  • Student disclosed that they or someone they know has drugs and/or a weapon on campus.
  • Student discloses certain sexual activity between minors and between adults. 

Student ID#: *
Student First and Last Name *
Grade level *
What would you like to meet about?  *
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