Lake Zurich High School > Student Assistance Program > Referral Process

Referral Process
Initial Student Assistance Program Referral Form  | Guidelines for Completing Referral Form

I.  An Initial Referral Form is filled out by teacher/staff person for any concern related to possible substance abuse or any academic, behavior or emotional problem.  The form is turned into one of the School Social Workers, the School Nurse, or Assistant Principal for Student Services.  Forms are located in the guidance department and the health office. Or you can click here to fill and print out a form online.

II.   SAP Core Team reviews referral information and makes determination as to whether the case may be a C.I.T. referral due to possible substance abuse problems.  If it is, then the following steps are taken.

        1. A C.I.T. Case Manager is assigned to gather information and bring it back to the team.         2. The C.I.T. reconvenes to review and assess information gathered.
        3. Action plan is determined.
                a. If there is no evidence other than one teacher’s report:
                    The case manager will review results with the referral source.
                    The referral will be kept on file.  The referral source and other teachers will be
                    encouraged to keep the team, informed of any new pertinent information.                   
                b. If  the C.I.T. has determined that there is a concern for possible substance abuse, then
                    a parent will be contacted by a member of the C.I.T. team to set up a meeting.
        4. A confidential conference will be held with the members of the C.I.T. and the parent(s).  
            Outside referral resources will be offered as well as resources within the school (not to be
            considered a replacement for the outside help, rather supplemental).
        5.  The case manager will send a Status Form to the original referral source.
        6.  Re-entry procedures will be followed upon return if hospitalized.

III.    If a C.I.T. referral is not indicated, then the Core Team will assign a SAP Case Manager and the following steps will be taken:
        1. The assigned SAP Case Manager is responsible for completing all information contained in
            the SAP Referral Record.
            This includes student information, data collection, team recommendations and evaluations. 
            Relevant information will be gathered as it pertains to a student’s situation, which may        
            include the following:
                a.  Attendance
                b.  Behavior
                c.  Discipline
                d.  Grades/Teacher reports
                e.  Health
                f.  Other observations from teachers, staff, and administrators
                g.  Police records
                h.  Social Work input
        2. The SAP Case Manager will assume the following responsibilities:
                a. Present findings at the next scheduled SAP meeting.  The Student Assistance Team
                    will determine appropriate interventions based on the findings.
                b. Initiate the intervention steps and will monitor progress of student.
                c. Update SAP team at weekly meetings as necessary.
                d. Complete evaluation section of SAP referral record
                e. Resume responsibility if the same student is referred again at any later time.


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