DO NOT USE 2024-2025 EYMS SNAP Parent Consent Form

Dear Parent:

Your child has been referred to the Eastern York Middle School Student Needs Assistance Program (SNAP).  This voluntary program is available to offer supportive services to students experiencing academic, behavioral, and/or emotional difficulties that may pose barriers to school success.  

Students can be referred to the SNAP by parents/guardians, school personnel, peers or self-referrals.  The SNAP team is composed of specially trained teachers, administrators, school counselors and a mental health and/or drug & alcohol consultant(s).   Our goal is to work with you and to offer support and recommendations for your child.  Where barriers are beyond the scope of the school, the team can provide information so families may access community resources. 

You are a vital part of the team and the SNAP team values the importance of parent/guardian involvement in this process.  A team member is ready to talk with you about the referral and obtain information about your child.  With your permission, our Student Needs Assistance Team will initiate the SNAP process which includes meeting with your son or daughter.

Please complete the questions on this form and indicate if you give consent to your child participating in the SNAP program.  If you have any questions about the Student Assistance Program, please email or call the SNAP team member that reached out to you. Thank you for being part of our team.


Sign in to Google to save your progress. Learn more
Email *
Student Name *
Parent Name *
Select if you give consent to your student participating in the SNAP program. *
Parent Initials (my initials will serve as my electronic signature) *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Eastern York School District. Report Abuse