NCS Crisis Response Team Referral-Remote Learning

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

In the event of a school closure (for example due to COVID-19) this form is used to identify individuals that may need support or to be contacted by a member of the Crisis Response Team. The Crisis Response Team is made up of behavior specialists, school social workers and other district staff that are available to support individuals struggling with a crisis. Referrals can be made by a staff member, parent, peer, or the individual requesting to be contacted.

Email *

Name of Individual Being Referred *

Name of Person Completing Form

Concerns (Why do you feel this person needs to be contacted? This helps with determining how to support the individual.) *

Contact Method- provide phone, email, etc. of the person you are are referring *

Best Time to Contact

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Niles Community Schools. Report Abuse

Forms