2023-2024 William Penn Building Student Assistance Program (SAP) Referral

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SAP Referrals are only checked during the school day, 8am-2:30pm. If you are making this referral during after-school hours and your concerns are urgent in nature, please contact the Lehigh County Mental Health Crisis Hotline at (610) 782-3127 to receive immediate assistance. If there is a life-threatening emergency, call “911” or visit your nearest emergency room. Additionally, anonymous tips regarding safety concerns, including those observed on social media can be reported confidentially through the Safe2SaySomething system (https://www.safe2saypa.org/what-is-safe2say-something/) or via telephone at 1-844-723-2729.

Please check observable behaviors and any comments for the student referred to the Student Assistance Program.

Date of Referral *

YYYY

Last Name of the Student *

First Name of the Student *

Check reasons for concern *

Drop in grades/ lower acheivement

Absence/tardies from school and/or class

Defies rules

Sleeps in class

Expresses sadness/hopelessness

Attention seeking/disrutpive beahvior

Expresses anger/hostility

Changes in personal appearance/self-care

Talks/boasts about use of alcohol or other controlled substances

Odor similar to marijuana/alcohol/nicotine

Others report concern for student use of controlled substance

Change in friends/social group

Speaks of family concerns/problems

Recent loss

Unexplained marks on body

Mood swings

Noticeable weight loss/weight gain

Possession/use of "vape" (electronic nicotine)

Bullying issues

Saddness and depressed mood

SI and self harm

Other:____________________________________________________

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