CARE Team Resource Request Form - ECHS 2023-2024
Instructions: Please use this form to request support for a student.  

The CARE Team meets weekly to reviews requests. We'll get back to you with next steps within 2 weeks.

Please complete this form with as much detail as possible.

IF YOU ARE CONCERNED a student is at RISK OF HARM to their self or others, please start by contacting one of the following - then complete this form:

1. In case of a life-threatening emergency, please call 911.

2. During the work day, please contact the following people and share your safety concern:
   
       *ECHS Administration: -- Call ECHS Front Office: 510-231-1437

                                                   *Jacob Gran, AP (Last Names A-Ga)
                                                   *Monica Ng AP (Last Names: Ge-N)
                                                   *Kate Bloomer, AP (Last Names O-Z)

3. Outside of regular business hours, contact one of the following for support & advice:

       *Seneca Mobile Crisis Response Team: (877) 441-1089 (24 hr support- by phone during COVID-19)
       *California Youth Crisis Line: 800-843-5200 (24 hour crisis support)
       *Contra Costa Crisis Center - 800-833-2900 (24 hour crisis support)

NOTE: Even if you have called due to a safety issue, please complete this form so we can follow-up.

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Email *
Person making this request: *
Student's Last Name *
Student's First Name *
Please check all concerns that might apply for the student: *
Required
Please provide information about what concerns you have for the student, and any other background information you think would be good for us to know:  *
Please let us know what has been already been tried to support the student (either in the classroom, at home, or in the community): *
Who have you discussed this CARE Resource Request with (ie: who have you talked with about your concerns or hopes for this student)? (check all that apply) *
Required
If you are not a WCCUSD staff member, please provide your contact information here.
If you are specifically requesting JMP (James Morehouse Project) individual counseling or a JMP group, please check below. If you know what group you are requesting, please write it in the response to the last question.
Thank you for answering these questions. Do you have any other comments at this time?
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