Social Emotional Support

STUDENTS:

If you need help, and it is not a life threatening emergency, fill out this referral form below.  Help will be provided by the next school day.

24 Hour support is also available: Teen Line 530-753-0797 and Crisis Text Line Text "HOME" to 741741

If you are currently having thoughts of suicide, immediately tell an adult or call 911. If you are unable to do that, call the Suicide Prevention Hotline at 530-756-5000 or 800-273-8255.  After you have received help, please fill out this form so a school staff member can follow up. 


TEACHERS/STAFF:

If you are concerned about a student's social emotional well-being, fill out the referral form which will be shared with a school counselor.

If you believe that a student is at risk for self-harm, immediately contact your school counselor and principal and fill out the referral form.

PARENTS/GUARDIANS:

If you are concerned about your child's social emotional well-being, and have been for two weeks or more, please complete the referral form below.  

If this is an emergency, please call 911 or take your child to the nearest hospital.  If you are unsure if this is an emergency please visit the Association for Children’s Mental Health website for more information. Also complete our form below so we are able to provide follow up care.



Referrals are confidential and are forwarded by email to the administrative team in the Student Support Services Department. Only those individuals with a need to know will be informed of the referral.

All referrals will be responded to within 24 hours or the next school day.


Social Emotional Support Form

Full Name 

School 

Grade 

Student's School Counselor 

Person Making the Referral





Phone Number (Include Area Code) 

Contact Email 

Please select all that apply: 






















Please describe what you or the student is experiencing: 

Have you or the student previously been treated for a mental health condition?



If yes to the previous question, what condition and which services have been provided?



Security Measure