Student Assistance Program - Parent/Guardian Consent

Your child has been referred to the Student Assistance Program (SAP). This voluntary program is available to offer supportive services to students experiencing academic, behavioral, and/or emotional difficulties that may pose barriers to school success.

Students can be referred to the SAP by parents/guardians, school personnel, peers or self-referrals. The SAP team is comprised of specially trained teachers, administrators, school counselors, nurses, a student and family relations specialist, a mental health liaison, and a drug & alcohol counselor. Our school team members are:

Nathan Otis - Principal
Dara Allen - Assistant Principal
Kathryn Hoffman - School Counselor
Amy Brown - Teacher
Matt Humes - Teacher
Joshua Richardson - Teacher
Emily Troncone - Teacher
Jessica Stetson - Teacher
Ian Williams - Teacher
Ryan Cassidy - Teacher
Mindi Fisher - School Nurse
Tyler Wilson - Computer Specialist

Kristen Righi - School Social Worker
Kaitlyn Adams - Student and Family Relations Specialist
- Truancy Liaison, Bethesda
Drug and Alcohol SAP Counselor, Pyramid Healthcare

Our goal is to work with you and to offer support and recommendations for your son/daughter. Where barriers are beyond the scope of the school, the team can provide information so families may access community resources.

Please complete the bottom portion of this form and click submit. If you have any questions about the Student Assistance Program, for Middle School students, please call Kathryn Hoffman - NEMS School Counselor, at (814) 725-8671 ext. 2005. Thank you for being part of our team!
I give my consent for the following for my child: (Child's name) I give my consent for the following for my child: (Child's name) First Last
Child's School Building
Please select all that apply:

Please select all that apply: To proceed with the Student Assistance Program. *By checking this box you are giving permission for the SAP team to discuss your child, gather additional information from parents/guardians and teachers, and if determined as the appropriate next step, to meet with the North East School District Mental Health Liason and/or the Pyramid Drug and Alcohol Counselor. In the case that the team believes it is appropriate for your child to meet with the Mental Health Liaison or the Drug and Alcohol Counselor, he or she will contact you prior to the initial meeting. I do not give permission to proceed with the Student Assistance Program
If you have checked the above box, please indicate with services you are interested in below. If you chose to not proceed with the Student Assistance Program, please check the bottom box.

If you have checked the above box, please indicate with services you are interested in below. If you chose to not proceed with the Student Assistance Program, please check the bottom box. To meet with North East School District Mental Health Liaison To meet with Pyramid Drug and Alcohol Counselor I opted to not proceed with the Student Assistance Program
Parent(s)/Guardian Signature:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date: Date: / MM / DD YYYY
Contact Number: Contact Number: - ### - ### ####
Email Address: