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Suicide: I am worried about...

Please complete the form below if you are worried about a student, a friend, or classmate and think they might be contemplating suicide.

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Enter contact information for the person filling out this form. You may remain anonymous if you wish.

First Name

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Last Name

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What school do you (or does your child) attend?*

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What grade are you (or is your child) in?*

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Please list the first and last name of student(s) of concern and/or people involved -- or provide additional information that can help us identify the student(s) such as information about which grade the student is in.*

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Please indicate your concern below and be as specific and detailed as possible.*

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Provide an approximate date of when the incident occurred.*

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Confirmation Email

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