Mental Health Day Requests
This form will be sent to the attendance office and to the IMSA Counselors. 

If remaining on campus - Student must report to the IRC by 9am the morning of their MHD. Student will receive an email from a school counselor with time blocks for student to report to counseling for their MHD check-in.
Student is responsible for checking in with a school counselor during the school day and checking in with their RC once in the evening.

If going home - The student must sign out for their MHD with ResLife the night before, with Security before 7am or with the Attendance Office no later than 10am. Student must check in with a counselor the next academic day that they are on campus. 

**A School Counselor will be following up with the student**
***Please note students are not eligible to participate in after school activities or extra curriculars on a day that they are taking a mental health day*** 
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Name of person completing this form *
Relationship to student *
Student's First Name *
Students Last Name *
Student's IMSA ID *
Student's Hall  *
Date of Mental Health Day *
MM
/
DD
/
YYYY
Will the student be on campus or at home for this Mental Health Day? *
Context (optional): Provide any information / details about why your student is requesting a mental health day to help IMSA better support your student. For example, are there particular academic or socioemotional stressors?
CONFIRMATION OF MHD REQUIREMENT Please check the box below to confirm that student understands that they are required to check-in with a counselor during their mental health day and their RC after 3pm *
Required
CONFIRMATION OF IDENTITY: Please check the box below to confirm you are a parent / guardian/RC of the student, and that you are listed as a parent / guardian/RC in IMSA's records. Should it be determined that any IMSA student has completed this form, it will be considered a breach of IMSA's Code of Conduct per the Student Parent Handbook. * *
Required
CONFIRMATION OF MULTIPLE MENTAL HEALTH DAYS PROCEDURE: Please check the box below to confirm you understand that if your student takes a second Mental Health day within the five day academic week span, the student is required to return home. * *
Required
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