Student Assistance Program Referral Form 2018-19
The Student Assistance Program is a state mandated program to identify and assist students. Students are referred regarding problem behaviors such as a decline in grades, suspected drug use or behaviors that inhibit learning. Anyone may make a referral. Referrals can be made anonymously except in the case of teachers or staff. It is expected in their professional capacity that teachers and staff identify themselves when making a referral. This information is confidential and not shared with the student.
IMPORTANT ** PLEASE READ**
Please note that if you have concerns regarding the immediate welfare of a child during the school day, such as suicidal ideations, self harm, or possession of weapons or drugs, discontinue this process and immediately contact a counselor or administrator. For similar concerns outside of school hours, please call 911.
Name of person making referral (optional)
Last name of student being referred *
first name of student being referred *
Grade of student being referred *
What is your role? *
Next
Never submit passwords through Google Forms.
This form was created inside of Lakeland School District. - Terms of Service