Parent/Guardian Inquiry for Therapy Services - Dana Middle School 
At Dana Middle School, we are committed to supporting the mental health and well-being of our students.  
Our school partners with therapy providers from:
  • YMCA Youth and Family Services
  • Family Forces Counseling Services for Military Families
  • Child and Youth Behavioral Military and Family Life Counseling Services (CYB-MFLC)
  • SDUSD's Mental Health Related Services (MHRS)
These partnerships allow us to offer mental health services to students on-campus, during or after the school day. If you believe your child could benefit from therapy services and do not have access to outside services, please complete the form below. This will help our team better understand your child’s needs and determine the best way to provide support.  All information shared will remain confidential and will be used solely to assist in your child’s well-being.  

If your child is experiencing a crisis, text HOME to 741741 for 24/7 free, confidential support or call the National Suicide Prevention Lifeline at 988.  In an emergency situation that requires immediate assistance, please dial 911.
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Student Name (First, Last) *
Parent/Guardian Name (First, Last) *
Type of Health Insurance *
Is a parent/guardian an active-duty member of the military? *
Does your child have an IEP (Individualized Education Plan)? *
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