Student and Family Wellness Form
Please complete this form if you would like to speak to your building home liaison about potential supports or concern surrounding issues including (But not limited to):

Student Mental Health Social Skills
Displacement/ Homelessness
Identifying community Supports
Attendance

Responses will be received and someone will reach out within 48 hours
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Email *
Name of person filling out this form and Relationship to student ? *
Student First and Last Name *
School *
Student Grade? *
How many children live in your house? *
Are you familiar with our food drive program? *
AREA(S) OF CONCERN 
Please provide some detail for the above concerns.
Days and times your are available to discuss your concerns. 
Best phone number to reach you? *
Will you accept text messages?
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A LIAISON WILL BE IN CONTACT WITHIN 48 BUSINESS HOURS AFTER THIS FORM HAS BEEN SUBMITTED.

PLEASE NOTE: STAFF DO NOT MAINTAIN 24/HR ACCESS TO EMAILS

IF YOU OR SOMEONE YOU KNOW IS IN CRISIS and it is an emergency Please contact one of the following.

Emergency:  Dial 911    (If you or someone else is suicidal, planning to harm self or are in danger)

Suicide Prevention and Emotional Distress Hotline and Texting (24 hours a day)   Dial 988 or Text 988

Frontline Mobile Crisis:   216-623-6888 (they also follow up)

Crisis Line Texting:  Text: 4Hope      To:  741741

Community Resources: call 211 or visit https://www.211oh.org/

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