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Student Concern (Staff Report)
Please complete this form when you have a concern related to a student's social emotional health, mental health, or safety.
*If the concern is immediate or imminent, contact an administrator.
*If this is an emergency,
call 9-1-1
.
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* Indicates required question
Student Name
*
Your answer
Grade Level
*
Unknown
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Required
School Building
*
Emerald Elementary
Manistique MS/HS
Jack Reque Alt Ed
St. Francis de Sales
Homeschool or Online
Required
Reporting Staff Member Name
*
Your answer
What is the nature of the concern?
*
Verbal statement
Written statement
Student behavior
Social media post
Other:
Required
Describe the concern in as much detail as possible.
**Be specific.**
*
Your answer
When did you become aware of the concern?
*
Your answer
Staff Response
*
I addressed the concern with the student. This is for documentation/awareness only.
I talked with the student, but administration follow-up is necessary.
I did not address the concern with the student. Administration follow-up is necessary.
Required
Why is administrative follow-up or response necessary?
*
Your answer
An administrator needs to meet with this student...
today.
tomorrow.
this week.
No administrative action is necessary.
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