High School SAP Student Referral Form
High School Student Assistance Program (SAP)
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Student referred: *
Grade: *
Your Name (Optional):
Relationship to student (check all that apply): *
Required
Referral of a student must be based on OBSERVABLE BEHAVIORS rather than rumors or opinions. Please list in detail the reason for the referral - Be specific about what you’ve seen or heard that concerns you. *
The high school SAP team members include: Brent Bell, Trystanne Bowman (Coordinator of Mental Health and Psychological Services), Joann Brim, Heather Crook (D&A Consultant), Jill Davis, Clint Gehring (Counselor), Alyssa Godsey (Social Worker), Cory McCartney, Cynthia Minnich, Lora Nestor (Counselor), Brooke Runkle, Jeff Seiler (Keystone MH Consultant), Abbey Walshaw-Wertz (Principal), Kristin Zigner (Nurse)

 *
If you want to have a SAP member contact you for further information, please give your phone number and/or email below.
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