Project AWARE Student Referral
Project AWARE offers cultural and mental and behavioral health counseling supports to students. If you believe that a student would benefit from participation with Project AWARE at school, please complete and submit this form. When this form is submitted, Project AWARE staff members at your school site are notified and then reach out to the student about whom this form is submitted.
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Your Name
Your Relationship to Student
Student's First Name *
Student's Last Name *
Student's Risk Level *
Your selection of a risk level helps Project AWARE prioritize responses to students. Selecting "High Risk" will lead to the quickest follow-up with a Project AWARE staff member.
Student's Living Address
Optional, complete only if known.
Issues of Concern
Optional, check all that apply.
Additional Information
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