Fountain City Elementary Caregiver Referral
Thank you for reaching out to your school social worker. Be aware that I do not check email except during school hours. If this is a crisis or emergency call 911 or go to your local emergency room.
Confidentiality- Information students share with the school social workers is confidential. The student’s right to privacy is guarded as much as permitted by law, ethics, and school policy. The school social worker is obligated to break confidentiality when there is potential harm to the student or others, concern of neglect or abuse, or a court of law that requires testimony of student records.
At times, the social worker and school-based staff (teacher, school counselor, principal, etc.) will need to exchange information about your child (how are they coping in class, strategies to help, etc.) All communication will take place only on a need-to-know basis.
E-mail transmissions may contain confidential health information that is privileged and legally protected from disclosure by the Health Insurance Portability and Accountability Act (HIPAA). This information is intended only for the use of the individual or entity named in the email. If you are not the intended recipient, you are hereby notified that reading, disseminating, disclosing, distributing, copying, acting upon or otherwise using the information contained in this e-mail is strictly prohibited.
Sign in to Google
to save your progress.
Grade level of child/children:
Names of siblings? (If they attend a KCS)
Best Phone Number (please enter (xxx) xxx-xxxx)
What are your concerns?
Access to technology and internet
My child/children need support
House hold needs
Mental health and counseling
Mentor support for student
I need help:
Finding a therapist/counselor for my child
Getting my student motivated to work from home
Finding resources for food, clothing, etc.
Getting ideas and suggestions on how to support my child
Getting ideas and suggestions on how to help improve my child's behavior at home
Could you please...
Do a check in with the student
Provide me resources, suggestions and tips on helping my child
Keep my student in mind if you put together any small groups
Contact me so we can talk more
Never submit passwords through Google Forms.
This form was created inside of Knox County Schools.