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)
Your answer
Last name of student being referred *
Your answer
First name of the student being referred *
Your answer
Grade of student being referred *
What is your role? *
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