PBIS Technical Assistance Request Form

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PBIS teams across Orange County are adapting to various settings and continue to need support developing, implementing, and problem solving PBIS systems and practices. Technical assistance from the OCDE Learning Support Services' PBIS Team may include topics such as:
- Adapting PBIS practices for virtual and hybrid settings
- Collecting and analyzing data to make decisions
- Refining Existing Interventions

Please enter the information below to begin the process of providing technical assistance to your team.

First and Last Name *

Job Title *

District Name

School Name

Phone Number *

Email Address *

Please provide 3 dates and times for the initial meeting: *

Which PBIS Tier (1, 2, or 3) is your team focusing on for these technical assistance sessions? *

Tier 1

Tier 2

Tier 3

Other:

Required

Please provide a brief description of the challenges and/or issues for which you would like assistance: *

What is your preferred method of assistance:

Video Conferencing/Phone call

In-Person Meeting

Other:

Clear selection

(Optional) Comments/Questions:

Submit

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