This student assistance form is meant to provide you with a system of support to deal with things that are beyond your control/expertise as a teacher/faculty member/service provider. The form is not a behavior referral form. If you are reporting a student infraction, please use your school behavior referral form.

Disclaimer: If this is a student emergency please contact the proper authorities (911, CPS – if you are a mandated reporter, etc.) along with submitting this referral.

Special-Ed Students: If the referred student has a Special Education IEP, please consult with their case manager before submitting a referral (not applicable to service provider)