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Mental Health Services for Rural Schools
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1
School & Contact Information
School District
Contact Name:
Title/Position:
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2
School & Student Demographics
Grade Levels Served:
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Elementary
Middle School
High School
Other
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3
Approximate Number of Students:
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4
How soon are you looking to implement services?
Immediately (Within 1-3 months)
Soon (Within 3-6 months)
Future Planning (6+ months)
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Other
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5
Additional Comments
Please provide any additional details or specific concerns regarding your school’s mental health needs:
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Mental Health Services for Rural Schools
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