Crisis Response Request Form
Crisis response and workplace support services are offered as a fee‑based resource, with distinct rate structures for nonprofit organizations, schools, and for‑profit businesses. A full range of hourly, daily, and multi‑day service options is available, with fees aligned to the organization type, duration of support, and staffing needs.
Please allow 24 hours* from the time of form submission for our Crisis Response Team to respond.
*Responses submitted over the weekend will receive a response on the next business day.
Your Name
*
First Name
Last Name
Title/Position
*
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
School/Organization Name
*
School/Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Person Who Died
First Name
Last Name
Relation to School/Organization
Cause of Death
Date of Death
-
Month
-
Day
Year
Date
Primary Date & Time Requested for Crisis Response
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Secondary Date & Time Requested for Crisis Response
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Age Group of Students
Number of Students Expected
Number of Adults Expected
If you have any additional comments for our staff, please enter below.
Submit
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