Hornet Care Team (Student & Parent Referral)
This is a scary time and we want to support each of every one of you to the best of our ability. Please use this form to refer either yourself, a peer, or your student to the behavioral health liaisons. Please answer all of the questions to the best of your ability. We will reach out to connect you with the best possible resource. Thank you!

Anna Kasel- Abilene Elementary & Wheatland Elementary

Courtney Craine- West Elementary & Intermediate School

Kellie Michaud - Valley Center Middle School

Jessica Van Tassell - Valley Center High School
Sign in to Google to save your progress. Learn more
Email *
Please type your name *
Name of the Student you're referring (if not self)
Best way to contact you
What school do you attend? (or person you're referring)
Clear selection
How are you feeling today? (Student) *
Are you experiencing one or more of these emotions? (Student) *
How can we best support you right now? (Student) *
Any additional information you'd like to share?
IF YOU FEEL you are in Need of IMMEDIATE help please reach out to the following:
-CALL 911 for emergency

-Text CONNECT to 741741 to visit with a trained counselor for 24/7 Crisis Support

-Call 988 for the National Suicide Prevention Lifeline


Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Valley Center, USD 262. Report Abuse