Eastern York Middle School Student Needs Assistance Program (SAP) Online SNAP Referral Form
Thank you for taking the time to care about the students here at Eastern York Middle School.

Please fill out the following information about the student. Please don't forget to click the submit button to ensure that we receive your responses. Your identity will remain anonymous unless you would like a member of the SNAP Team to talk to you.

Student Name *
Your answer
Enter that student's grade level *
Is that child in immediate danger? *
Please indicated the reason(s) for referral by checking any and all of the appropriate observable behaviors
Academic Performance
School Attendance
Physical Observations
Disruptive Behaviors
Atypical Behaviors *
(Please remember to report ONLY observable behaviors, not opinions)
Your answer
Would you like to speak with a member of the SNAP Team?
What is your name? (You only need to enter your name if you would like to speak to a SAP Team Member. Your name and your referral will be kept confidential.)
(Last Name, First Name) Example: Jones, Sally
Your answer
What is your relation to the student being referred? *
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