Arroyo Seco Request Form
For additional support, please see listed resources below:
CA Peer-Run Warm-Line: 1-855-845-7415
Child and Family Center Crisis Line: 661-259-9439
988 Suicide & Crisis Lifeline, 24 hours: Call or Chat 988
Blackline: 1- 800-604-5841
CA Youth Crisis Line: 800-843-5200
Contact the Crisis Text Line by texting HELLO to 741741
Teen Line, only 6pm-9pm: 839863
The Trevor Project, 24 hours: 1-866-488-7386
USDA National Hunger Hotline, Monday-Friday 7am-10pm
English: 1-866-348-6479  Spanish: 1-877-842-6273
Please click here for assorted community resources.
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Email *
First Name *
Last Name *
Student ID Number *
Grade *
Required
Rate of support  *
Briefly describe how we can help *
I would love to check in with *
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I hereby certify that I am 12 years of age or older and I am the individual stated above to seek out mental health support services from a social worker at my school wellness center and/or school social worker’s office.

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I understand that requests can only be addressed during normal school hours.  If it is after hours, the weekend, a holiday, or non-student day, your request will not be seen until the next school day at the earliest.  If you are having an emergency, please tell a trusted adult or call 911.

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