Connected Community Schools Request for Assistance
Connected Community Schools Leaders in Network Knowledge, or LiNK, is here to help serve as a ConnectLine between you and whatever services or assistance you need. If you or your family is struggling and would like to talk to one of our Connected Community resource experts, fill out this self-referral form and we'll get in touch to help make these Connections any way we can!
*Please note - this form must be completed by someone 18 years of age or older. This form is also not for emergencies - if you or someone you know is in a crisis situation/in need of emergency assistance, please call 911.
Name and DOB
"John Smith, 12/31/1975"
(select all that apply)
Town of Webb
None - no one in household attends or will attend school
Phone Number (###-###-####)
Preferred Time of Contact
Best way to reach you with questions regarding this form
Area(s) of Concern/Need
Select all that apply
Mental Health and/or Behavioral Health
Other - Explain Below
Please provide a summary of what you would like assistance with:
Do you have insurance?
If yes, do you have medicaid?
Send me a copy of my responses.
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