NCS Crisis Response Team Referral-Remote Learning
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.
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.
Never submit passwords through Google Forms.
This form was created inside of Niles Community Schools.