STUDENT ASSISTANCE PROGRAM INFORMATION AND FORMS
This page provides a variety of information to help you define the purpose and
goals of your program; create new or revise current forms; and communicate clearly
to staff, students and parents. We encourage you to download and edit these materials
to suit your needs. We ask only that you credit The Governor's Prevention Partnership
when you use our materials.
General Information
SAP Overview - An explanation of Student Assistance Programs, typical program goals and potential
outcomes. This language can be useful if you're creating a brochure or making
a presentation.
Student Assistance Program components - A graphic showing the five components of a complete SAP and bulleted lists
of the activities associated with each component.
The Shift to a Strengths-Based Approach - You may find this graphic helpful in making presentations about SAP.
Forms
Pre-Referral Interventions - A checklist of possible interventions that a classroom teacher should try
before referring the student to SAP.
Sample Referral Form - The first page is a checklist for the coordinator. The second page may be
filled out partially by the referring teacher and partially by a team member,
depending on your team's procedures. You can edit this page so that it clarifies
which information the referring teacher completes and reflects the data your team
needs. Pages 3-5 are completed by the teacher, and page 6 is for the nurse.
Don't be put off by the length. Much of the form is in checklist format and can
be completed quickly. This provides the team with extremely useful information.
Sample Parent Notification Letter - There is an English and similar Spanish version.
Strengths-Based Parent Interview - A format for conducting an interview with parents. This could be in person,
over the phone or modified to a survey format. Interviewers will need to decide
which questions to ask, and they can adapt the language to their own interviewing
style.
Strengths-Based Student Interview - A format for conducting an interview with students. Interviewers will need
to decide which questions to ask, and they can adapt the language to their own
interviewing style and the student's age and abilities.
#1 Gap Analysis Action Plan & #2 Gap Analysis Action Plan - These are two slightly different versions of the action planning form. You'll
notice that while the steps on the first page are the same in each version, the
placement of the steps is different. In the first version, the information about
the student's current functioning is on top, and the desired outcomes are on the
bottom. In the second version, Strengths and Needs are next to each other, and
Behaviors of Concern and Desired Outcomes are next to each other because in both
cases, one is somewhat the opposite of the other. You can decide which version
you like best.
You can print either of these on 8 ½ x 11 paper or 11 x 17. Many teams like
the 11 x 17 format because it's easier for all to read.
Surveys
Sample Student Satisfaction Survey - for students who have been or are in the program.
Sample Staff Satisfaction Survey - for school staff
Sample Parent Satisfaction Survey - for parents whose child has been or is in the porgram.