CARE Team Resource Request Form - ECHS 2024-2025
Instructions: Please use this form to request support for a student.  

PLEASE NOTE - THIS IS A NEW FORM TO REQUEST SUPPORT FOR A STUDENT FOR THE 2024-25 SCHOOL YEAR!!

The CARE Team meets weekly to reviews requests. We'll get back to you with next steps within 2 weeks.

Please complete this form with as much detail as possible.

IF YOU ARE CONCERNED a student is at RISK OF HARM to their self or others, please start by contacting one of the following - then complete this form:

1. In case of a life-threatening emergency, please call 911.

2. During the workday, please contact the following people and share your safety concern:
   
       *ECHS Administration: -- Call ECHS Front Office: 510-231-1437

                                                   *Nancy Flocchini, AP (Last Names A-Ga)
                                                   *Monica Ng, AP (Last Names: Ge-N)
                                                   *Kate Bloomer, AP (Last Names O-Z)

3. Outside of regular business hours, contact one of the following for support & advice:

       *Seneca Mobile Crisis Response Team: (877) 441-1089 (24 hr support- by phone)
       *California Youth Crisis Line: 800-843-5200 (24 hour crisis support)
       *Contra Costa Crisis Center - 800-833-2900 (24 hour crisis support)

NOTE: Even if you have called due to a safety issue, please complete this form so we can follow-up.

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Email *
1. Person making this request:  *
2. Student's Last Name *
3. Student's First Name *
4. CONCERNS - Please check all concerns that might apply for the student: *
Required
5. Background Info - Please provide information about what concerns you have for the student, and any other background information you think would be good for us to know:  *
6. Previous Supports - Please let us know what has already been tried to support the student (either in the classroom, at home, or in the community): *
7. Others Involved - Who have you discussed this CARE Resource Request with (ie: who have you talked with about your concerns or hopes for this student)? (check all that apply)  *
Required
8. Phone Number:  If you are NOT a WCCUSD staff member, please provide your phone number here.
9. JMP Request - If you are specifically requesting JMP (James Morehouse Project) individual counseling or a JMP group, please check below. If you know what group you are requesting, please write it in the response to the last question.
10. Comments - Thank you for answering these questions. Do you have any other comments at this time?
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