Riverside Elementary Student Assistance Program (SAP) Initial Referral Form 2016-17
The Student Assistance Program 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 SAP referral. Referrals may be made anonymously except in the case of teachers or staff. It is expected that teachers and staff identify themselves when making a referral when working in their professional capacity. This information is confidential and not shared with the student.

Email address *
Name of person making referral *
Your answer
Last name of student being referred *
Your answer
First name of student being referred
Your answer
Homeroom Teacher of student being referred *
Your answer
Grade of student being referred *
What is your role? *
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