Crusader request for support form/ Crusader pedir ayuda forma

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If you feel you are in crisis after school hours, please contact one of the following hotlines for support/ Si necesitas ayuda despues de los horas de escuela habla a estes numeros de telefono: TEEN LINE 310-955-4673 or 800-852-8336 the National Suicide Prevention Lifeline is 800-273-8255.

Your Name/ Tu Nombre *

Your student ID number/ Tu numero de estudiante *

What do you need help with?/ En que necesitas ayuda? *

Class/ Grades- Clase/ Grados

Teacher/ Staff member- Maestro/ Personal

Myself/ Personal- Yo mismo

Friends- Amigos

Family-Familia

Bullying/ Peer-pressure- Bullying/ Presion de groupo

Other- Otra cosa

Do you want to talk to someone specific about the problem, if so who? Si quiere hablar con alguien specifico, quien sera? *

Mrs. Strongin

Mr. Walker

Ms. Gabi

Ms. Tyler

Mrs. Rowe

A CPAL- write their name on "additional information"/ Ponte el nombre de el adulto donde dice "mas informacion"

A specific teacher- write their name on "additional information"/ Un maestro specifico- ponte el nombre donde dice :"mas informacion"

Anyone- No importa quien

What is the best way to contact you? Que es la manera mejor para contactarlo? Example: Please call me- 661-325-2222 *

Additional information you would like us to know? Si tiene informacion adicional que quiere que savemos?

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