Student Assistance Referral
Please complete the form below to  share concerns that you have about a student. Please complete the form as thoroughly as possible. Based on your report, various interventions may be considered, including Student Assistance Program (SAP), Pupil Focus, Truancy Intervention and Prevention Program (TIPP) or any other intervention program deemed necessary.

This form is CONFIDENTIAL.

If you have concerns about suicidal or homicidal ideation, please immediately report this to a counselor or principal.

If you have a serious concern about a student during school hours, please contact a school counselor or an administrator immediately (in addition to submitting this form).

If you have serious concerns about a student outside of school hours, please go to Safe2saypa.org and complete a report. If you are in need of SPHS CARE Center Crisis Intervention Services, please call the 24-hour crisis hot-line: 1-877-225-3567.

Email *
Date *
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Name of Person Referring *
Email of Person Referring *
Relationship to Student being Referred *
Name of Student being Referred *
Grade Level *
Required
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