Request for Support During Distance Learning 2.0

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Please complete this form to request support (for yourself or a student). The intent of this form is to is identify and respond to observed student needs as soon as possible.

THE PROCESS:
1. Once you finish the request, you will receive a confirmation "receipt" via email that the form was successfully submitted.

2. Staff will receive an email alert of your request and will review the form and connect with the staff person who will respond to the request.

IN WHAT KINDS OF SITUATIONS CAN SUPPORT BE PROVIDED?
If you are concerned about a student's learning or well-being, REACH OUT FOR SUPPORT! Needs can include technology issues, attendance, basic needs, academic or mental health concerns, to name a few.

Email *

Your Name and Contact Info: *

Student Name *

Student # (if you know)

Student's Grade

Urgency Level of this Request

Not urgent - a one-day follow-up timeline is just fine

Mildly urgent - resolution by the end of the day would be fantastic!

Very urgent - I would love it if someone could email or call me within two hours!

Other:

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Brief description of concern: *

What kind of support are you seeking? (select all that apply) *

Attendance Issues; Student has had multiple unexcused absences.

Student may be homeless (includes doubled up with friends or family) or there are other basic needs..

Student is attending, but has not submitted assignments.

Social emotional or mental health concerns

Student may benefit from an academic check in

Information and/or support for me.

Student or family has health related concerns

Student Technology Issue

Questions about 504 Plan or Special Education services

Other:

Required

What actions have you already taken to address this concern? What have the outcomes been? *

Is there information or unique circumstances that the responder should be aware? Share facts and just enough information to direct this form to the correct person.

A copy of your responses will be emailed to the address you provided.

Submit

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