Request for Assistance
Greetings Families,

This form can be used to request a check-in with a counselor for your student, and/or to get connected with resources.

A request for a check-in is available to every student, and does not necessarily imply the need for ongoing social/emotional support. Once the check-in is complete and after consultation with other staff that know the student, we will be better able to assess to best address the needs of your child. Outcomes may include just the check-in, offering continuing services, referring to other resources and programs outside of the school, or other recommendations.

Thank you,
Ms. Rachel
School Counselors

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Email *
Your name (who is requesting the check-in/resources on behalf of the student): *
Your relationship to the student: *
Name of the student needing a check-in/resources: *
Grade of student *
I am requesting: *
Please describe the resources you are in need of assistance with: *
Please describe the reason you are requesting a check-in: *
It is recommended that a guardian be home during the check-in in case of emergency. Please choose a time slot(s) for the check-in:
Monday
Tuesday
Wednesday
Thursday
Friday
8am-11am
11am-1pm
1pm-4pm
Do you prefer a phone call or zoom check-in? *
Phone number (used to schedule the meeting, run the meeting if you prefer a phone meeting, and to call in case of emergency) *
24/7 Crisis Lines are available if you need someone to talk to:
Sacramento County Crisis Line: (916) 875-1000
National Lifeline: 1-800-273-8255 or (916) 368-3111
Text 'HOME' to 741741

If you are experiencing a life-threatening emergency, please call 911 or go to the nearest ER. If you are experiencing a mental health crisis, you can visit the Mental Health Urgent Care Clinic during business hours (10am-10pm weekdays and 10am-6pm weekends).
Mental Health Urgent Care Clinic
2130 Stockton Blvd, Building 300, Sacramento, CA 95817
(916) 520-2460
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