Worried About Someone?
Please complete this form if you are Worried About Someone and/or if you think that they may need to speak to a counselor.

During School Hours: If you or someone you know is having thoughts of suicide or thoughts to hurt others, please report to the counseling center or tell a trusted adult immediately.

After School Hours: If you or someone you know is having thoughts of suicide or thoughts to hurt others, please tell a trusted adult, call or text the Suicide Prevention Lifeline at 988, or contact 911.

If a student is in danger of hurting themselves or others, please contact the counseling center or tell a trusted adult immediately. Do not wait....See something, Say Something, Do Something!
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Email *
Date: *
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Your name (first,last): *
Name of student you are concerned about (first,last): *
Do you wish to remain anonymous when the student is contacted? *
Building: *
Grade (if known): *
Did the student indicate any threat of or potential harm to self or harm to others? *
Concerns (check all that apply): *
Required
Summary of Concern:
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