Wells ISD

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Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.

Report Suicide Concerns

If you or anyone is in immediate danger, please call 911.

Date of Incident:

Date of Report:

Who is the person of concern?

Grade of the person of concern?

Was suicide mentioned by the individual?

Yes

Other

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

Person reporting the incident:(OPTIONAL). Please use your full name.

May we contact you for more information on this incident?

Yes

If you or any individual is struggling with suicide or suicidal thoughts please call the Suicide Prevention Hotline located below.

1-800-273-8255

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.

Email a copy to

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Required Fields

Report a Suicide Concern