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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