This form is intended to help connect students with a school based mental health professional. Counselors: Guy Gordan and Rebecca Ewald; SEL: Kari Gray
Who are you referring?
Was there anyone else involved? (names here)
From your perspective, what happened?
What was your response at the time? What did you try so far?
When would you like a response by?
Soon-it's ok to wait until next week
If you find yourself or another in a crisis these resources are available and you are encouraged to use these in addition.
1-844-493-8255 or Text TALK to 38255
A local walk-in crisis center is located at Jefferson Center’s Crisis & Recovery Center at
4643 Wadsworth Blvd., Wheat Ridge, CO 80033
Or Facebook Messenger
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools.