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Request for CARE Team Consideration
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Name of person making request and relationship to the student
*
Your answer
Please select the school that the student attends:
*
Lincoln
Radcliffe
Spring Garden
Washington
Yantacaw
John H. Walker Middle School
Nutley High School
Other
Select the grade the student is in for the 24-25 school year.
*
PreK
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade / High School Freshman
Tenth Grade / High School Sophmore
Eleventh Grade / High School Junior
Twelfth Grade / High School Senior
Required
In which areas does the student have difficulties?
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Academic
Behavioral
Emotional
Physical Health / Medical
Other:
Required
What assistance does the student need?
To best be able to support the student, please explain what impedes/prevents/interferes with student learning.
*
Your answer
What are the student's strengths?
*
Your answer
What, if any, specific accommodations are you seeking?
*
Your answer
Which of the following major life activities does the physical/medical/psychological condition impact?
*
Hearing
Waling
Seeing
Speaking
Breathing
Learning/working
None
Required
Do you have medical documentation of the student's condition indicating its impact on a major life function?
*
Yes
No
Send me a copy of my responses.
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