CARE (SAP) Team Referral
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Email *
Student Name *
Grade Level *
Required
Would you like to make an official referral to R.E.A.C.H. for mental health counseling?
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Reason for Referral (Check all that apply)
Briefly explain the reason for this referral: *
Academic Concerns  (Check all that apply, or skip if this area is not a concern)
Disruptive Behavior  (Check all that apply, or skip if this area is not a concern)
Class Attendance (Check all that apply, or skip if this area is not a concern)
Physical Appearance (Check all that apply, or skip if this area is not a concern)
Social /Emotional Behavior (Check all that apply, or skip if this area is not a concern)
Would you like to speak with a member of the Student Assistance Team? *
Person making referral:   (May be anonymous)
Relationship to Student *
Required
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