BSMS YSC Student Referral Form
Are you or another student struggling in an area or would you like information from the Youth Service Center.  Complete the form below and Mr. Evans will be reaching out to you.  Remember, anything you say to Mr. Evans or put on this form stay confidential, something presents a danger for you or someone else.

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Your First and Last Name *
Are you submitting this form for yourself or another student? *
What grade are you in? *
Please check all areas that you are requesting help or information about. *
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