NCS Critical Support Team Remote Referral
If a crisis has occurred and you need support, please use this form. Someone will contact you ASAP
Sign in to Google to save your progress. Learn more
Email *
Name of Individual Being Referred *
Name of Person Completing Form
(If different than the person being referred)
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
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Niles Community Schools. Report Abuse