School Social Worker Referral Form
If you have an emergency, please call 911.
If you suspect abuse or neglect of a child, you must call the Tennessee Department of Children's Services at 877-237-0004 or 877-542-2873.
Please understand that, due to confidentiality laws, you may not receive any updates about the status of your referral.
Name(s) of referred child(ren)?
Your Phone Number
Your relationship to the child(ren).
Other School Staff
Other Not Listed
If you answered "Other Not Listed" above, please state your relationship to the child(ren) being referred.
Reason for Referral
Special Education Services
Other (please explain below)
If you checked "Other" above, please explain the referral.
Never submit passwords through Google Forms.
This form was created inside of Knox County Schools.