CROSS Team Initial Referral Form 2016-17
The Student Assistance Program/CROSS Team is a state-mandated K-12 program designed to assist school personnel in identifying issues including alcohol, tobacco, other drugs, and mental health issues which pose a barrier to a student's success.

Anyone may make a CROSS referral. This information is confidential and not shared with the student. CROSS Team members include:

Al Callejas
Cathy Chiumento
Tim Czyzyk
Lisa Harris
Kim Kanuik
Alexa Schoenberg
Kandy Taylor

Name of person making referral
Your answer
Last name of student being referred
Your answer
First name of student being referred
Your answer
Grade of student being referred
What is your role?
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