Cumberland Valley K-12 Student Assistance Program Referral Form
Please fill out this form if you have concerns about either substance abuse or mental health of any student K-12 in the Cumberland Valley School District. The school counselor will take this referral information to the Student Assistance Team for follow up and action.
* If you are concerned about the imminent safety of a student, please make this report through Safe to Say (
) for a 24/7 response. *
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The Student Assistance Program consists of a team of caring adults in each building who work to connect students who are experiencing difficulty. Referrals to community liaisons are made and information is shared with the parent/guardian as well as possible recommendations for services in the community.
CV High School (Grade 10-12)
CV 9th Grade Academy
Eagle View Middle School
Mountain View Middle School
Green Ridge Elementary
Silver Spring Elementary
Sporting Hill Elementary
Winding Creek Elementary
CVVA - Cumberland Valley Virtual Academy
Type of Concern
Reasons for Concern
Name of Person Referring
Phone Number of Person Referring
Email of Person Referring
Other Way to Contact You
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This form was created inside of Cumberland Valley School District.