MD Handle With Care Notification Report

Maryland Handle With Care Notification Report
Name*

First NameLast Name
Email*
example@example.com
Select Month/Year Reporting*
County Reporting*
Number of notices sent*
Number of students affected*
Number of students referred to mental health services within the school*
Number of students referred to mental health services outside of the school*
If mental health referrals are zero, please indicate below if there were no mental health referrals this month or if the data was not collected.
Mental Health Referrals*
Number of notices sent by agency
Please use the space below to provide general feedback and success stories.
General Feedback
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Maryland Handle With Care Notification Report