Student Assistance Program - Parent/Guardian Consent - High School

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 composed of specially trained teachers, administrators, school counselors and a mental health and/or drug & alcohol counsultant(s). Our school team members are:

Dr. Bill Renne - Principal
Asa McCullum - Assistant Principal
Dawn Coletta - School Counselor
Laura Panek - School Counselor
Matt Puskar - School Counselor
Christie Austin - School Nurse
Nicole Fitch - Librarian
Morgan Gulley - Teacher
Samantha Jones - Teacher
Ryan Neal - Teacher
Demi Nelson - Teacher
Heidi Martin - Mental Health Liaison
Kyle Regan - Teacher
Leslie Shickler - Teacher
Kristin Righi - School Social Worker
Mackenzie Courtney - School Psychologist
Pyramid Healthcare/Drug and Alcohol Counselors - Nicholas Jakubowski/Jessica LaFlamme

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 High School students, please call Heidi Martin - NEHS SAP Counselor, at (814) 725-8671 ext. 1504. 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 and for the SAP team to discuss my child. The SAP team includes the North East School District Mental Health Specialist and a Drug and Alcohol liaison/counselor from Pyramid Behavioral Health. To meet with Pyramid Drug and Alcohol Counselor for an assessment and counseling for prevention and intervention purposes. To meet with North East School District Mental Health Specialist for assessment and counseling purposes. I do not give permission to proceed with the Student Assistance Program
Parent/Guardian Name: Parent/Guardian Name: First Last
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
Best number to contact you at: Best number to contact you at: - ### - ### ####
Email Address: