Student Assistance Program Referral Form 2019-20
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
Name of person making referral (optional)
Last name of student being referred
First name of the student being referred
Grade of student being referred
What is your role?
Page 1 of 4
Never submit passwords through Google Forms.
This form was created inside of Lakeland School District.