Holy Spirit Health System - Teenline Program K-12 Post Training Application of Skills - (School Personnel) Name (PLEASE PRINT): School Distriet/Bulng: Derry township} tershey Early Childhaed Cente Dates Attended Training: March 5, 6,7, 2013 Exp. Date: September 5, 2013 ‘Assignment Date Participant | Mentor Completed Initials Initials 7) List the agency liaisons that are utilized by your team (if applicable). i Y A) a__-Kesstone Qu-|3 8) Derry Township Pa lice/seo} ie NP ye 9 2) Uist at least three in-school supports that the SAP team may utilize when assisting a student. a) School Counselor AB er 14! | Kil 8) School Nurse, 4 if 9 School Psyc. Ment, 3) List at least three community resources that are avallabe to students at your school, is Pisin Pp aD f Al Al o) Children + Youth ‘ ya" oKwanis Club 4) Go tothe SAP website, www.sap state,pa.us, and familiarize yourself with the offerings available on this website. Review three items and identify and list them below. 9 Epos Best Pookie cb oy.13 [AP | vit! ») Sample. Documents — c) Resource Center: Informationa | PamphletsHoly Spirit Health System - Teenline Program K-12 Post Training Application of Skills - (School Personnel) 5) Review your school’s SAP team flow chart 4. 24 B mv ust 6) Review your SAP team’s policy on confidentiality q -24-13 | ANP | yee 7) Review your schools policy on SAP record keeping. Where are records kept, how long r , are records maintained, who can see SAP records, | 4 ~ 244-13 eNP what's the policy/procedure for releasing ya" records?, etc. 8) Observe a SAP-certified team member initiate parental contact (face-to-face or via phone) and P Sbtain permission for SAP to proceed * 4-24-13 | AN | 9) Observe a SAP-certified team member ve interview a student.* 14-24-12 | ZN P | yet yi 10) Be observed interviewing a student.* 4 24-12 kN e ‘Items 8-10: If you are in a role that would disallow this or that will not be a part of your role in SAP, (i.e, SAP secretary, central office person/school administrator, etc.) please list your role here and state not applicable (N/A) in table above. |, the undersigned, served as SAP Program Mentor to the above identified SAP Training Participant and hereby verify that | have met with him/her to discuss the local SAP Program and that to the best of my knowledge he/she has completed the planned post-training learning activities identified above, SAP Program Mentor: Lig M. Svihen - Miller vate:_4-24-)2 Please Print SAP Program Mentor: ie Mt shbhMiLle, a ‘SAP Mentor Signature 7