Student Assistance Program (SAP) Initial Referral Form 2019-2020
The Student Assistance Program is a state-mandated K-12 program designed to assist school personnel in identifying issues including alcohol, tobacco, other drugs, and mental health issues which pose a barrier to a student's success. It is a method for trained school personnel to intervene and refer these students to appropriate school and community services, as well as appropriately following up after the referral. **If the concern is academic, please refer to our Instructional Support Team. If you feel low grades are a symptom of something else (i.e. grief, depression, outside factors, etc.) please complete this form.

Anyone may make a SAP referral. Referrals may be made anonymously except in the case of teachers or staff. It is expected that teachers and staff identify themselves when making a referral when working in their professional capacity. This information is confidential and not shared with the student.
Name of person making referral (optional)
Your answer
Last name of student being referred *
Your answer
First name of student being referred
Your answer
Grade of student being referred *
What is your role? *
Month of referral
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