CONFIDENTIAL - What may I help you with today?

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My name is Mrs. Ellen Lowe and I am the Special Programs Director for Junction City School District. I can be reached at 870-899-4046 or email lowee@jcdragons.k12.ar.us. I am here to answer your questions on any needs you may have or steer you in the right direction. This is a confidential form and all responses are private and will only be sent to me and seen by me. Your needs are important to us! Once this form is completed and submitted, I will be in contact with you! I'm here to help!

Your Name *

Are you a student or parent/guardian? *

Student

Parent/Guardian

If student, what grade are you in?

What is your mobile phone number? *

What is your home phone number?

What is your email address?

How would you like to be contacted? *

Voice Call

Text

Meeting in my office

Other:

Required

Please check all services you are in need of or desire: *

Free Lunch/Breakfast

Clothing

School Supplies

Counseling

Medical/Dental referral

Vision Referral

Medicaid/DSHS services - food stamps

Birth Certificate

Backpack Program

College & Career Readiness

Immunization/Medical Records

Tutoring

After-School Programs

Mentoring

Special Education

Gifted/Talented

Community Resources

Prior Academic Records

Guardianship Issues

Food Pantries

Hygiene Needs: Feminine Products, Soap, Deodorant, Shampoo, etc.

Parenting Information

Other:

Required

Is there any other information you would like for me to know or help you with?

Submit

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