CRIS Student Assistance Program Referral Form

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The Student Assistance Program (S.A.P.) is a state mandated program to identify and assist students. Students are referred regarding problem behaviors such as a decline in grades, suspected drug use or behaviors that inhibit learning. Anyone may make a referral. Referrals can be made anonymously except in the case of teachers or staff. It is expected in their professional capacity that teachers and staff identify themselves when making a referral. This information is confidential and not shared with the student.

Student's LAST Name: *

Student's FIRST Name: *

Enter the student's first name

Student's Building: *

Select the student's building

Clear Run Intermediate School

Required

Student's Grade: *

Select the student's grade

Referral Source *

Select what best describes relationship with the student

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