Jean Coldsmith Mental Health Program
The Jean Coldsmith Mental Health Program helps remove financial barriers to mental health care for Teton County School District #1 (TCSD) students who would otherwise be unable to access needed services. The program provides funding for up to 10 mental health counseling sessions per qualifying student, with the goal of addressing immediate mental health needs, improving student well-being, removing barriers to learning, and supporting students' ability to succeed in school. Eligible students must have an identified mental health need, as assessed by a school counselor or social worker, and lack adequate health insurance coverage and the financial resources to pay for services out of pocket. Pre and post indicators will be used to determine impact of mental health sessions.
Recommender's Name
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First Name
Last Name
Recommender's Email
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example@example.com
Student's WISER ID
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Student's Full Name
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First Name
Last Name
What school does this student attend?
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Please Select
JES
CES
MMES
AES
WES
KES
MES
JHMS
JHHS
SIS
Student's Grade
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Please Select
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Does this student have health insurance? If so, what kind?
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Does this student qualify for McKinney Vento funds?
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Yes
No
I'm not sure
Have other funding sources been exhausted for this student?
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Yes
No
Has this student previously received funding through the Jean Coldsmith Fund?
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Yes
No
How many sessions are you requesting (Max 10)
Please indicate reason(s) for referring tis student to the Jean Coldsmith Mental Health Program. Which barrier(s) to learning is this student facing?
Panarama Survey
Attendence
Behavior
Grades/Course Performance
Other - Please explain needed intervention that has impact on school (provide explanation below)
Please describe needed intervention that has impact on school and any other information that will help determine impact reporting for this student.
Submit
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