Guidelines for Completing Referral Form

When referring a student to SAP, it may be helpful to review the following examples to determine if a referral is appropriate at this time.  If, after reviewing these examples, you would like to refer a student, please complete an Initial SAP Referral Form.  Forms are located in the guidance department or health office.

CHANGES IN ACADEMIC PERFORMANCE

·        Earned a "B" the 1st quarter and has dropped to a "D" for the 2nd quarter.  Performance does not match ability.

·        Until the last 3 weeks or recently, has completed assignments and participated in class.  Now, rarely volunteers and often cannot answer if called upon.

CHANGES IN BEHAVIORS AND PHYSICAL APPEARANCE

·        Now isolates himself/herself from previous friends and says he/she hates everyone in class.

·        Behavior changes visibly from day to day.  Some days is an alert participant and other days, silent and withdrawn.

·        Appears tired and uninvolved at the beginning of the week.  Towards the end of the week participates more in class.

·        Appears fatigued and puts his/her head down on the desk 3 out of 5 days a week.

·        Frequent tardiness/absences

·        Aggressiveness:  increased physical or verbal contact; pushing, harassing, or intimidating other students.  "On four occasions in the last 2 weeks, I have seen the student engaged in this kind of behavior in the hall."

·        Hyperactivity:  unable to sit still for 15 minutes.  Shuffles feet, shakes leg or feet, taps hands, twitches, rocks back and forth, acts silly.

·        Lethargy: sleeps in class; frequently appears confused when asked questions or given directions.

·        Forgetfulness:  cannot remember assignments.  Has not kept several appointments with teacher despite promises to do so.  Always has a new excuse.

·        Defiance or Hostility:  refuses to comply with requests.  "Send me to the Assistant Principal.  I just want to get out of here."

·        Student Comments:

-Resists attempts to be involved in class.  "This stuff is stupid.  I do not need to know this.”

-Frequent drug or alcohol related talk.  "I partied big time this weekend and got wasted.”

     -Denies fault - "I wasn’t doing anything. You are always picking on me.”