Request for Support

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Request for Support

This form can be filled out to request support from the PiM Counseling & Social Work Departments. **If this issue is an emergency or you feel unsafe, please go to the Learning Center if you have an IEP or 504 or the front office for anyone else**

* This form is a request, not an appointment. If you are asking about a schedule change, you will be emailed to start the conversation. Thank you.

Please note that this form is only monitored during the school day (7:30-2:30 pm) when school is in session.

Email *

First and Last Name *

I am a

Student

Parent

Clear selection

I or my student has an IEP or 504 Plan *

Yes, IEP

Yes, 504

This request is in relation to *

Personal/Social Concerns

Academic Concerns

College/Career Questions

Scheduling Concerns (Can request a change into the first 5 days of the quarter)

If a Schedule Concern; which valid reason to change does this fall under?

A need to recover a failed course/Failing first quarter of a two-quarter class

Missing the prerequisite(s) of the course enrolled in

Change of Major/Focus

Empty block or enrolled in a course I already took and passed.

Approved request to Senior Capstone, Self-directed Study, Teacher Assistant

Clear selection

I want to meet with *

Deb Klein (Social Worker)

Sarah Jane Klein (Counseling/Scheduling Concerns)

Angela Lobe

Monty/Montgomery (Dir of Student Life)

Schauwitzer (Dir of Teaching and Learning/Teacher or Class Concerns)

Stephanie Soskin (College and Career)

I am not sure who can help

I would like this person to contact

Just me

Both me and student/parent

Clear selection

I would like to meet with someone *

Today if possible

Tomorrow is fine

Next week works

Before the end of the quarter

By email is fine

Required

Submit

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