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Mr. Bartusek (A-Fe last names) Appointment Request Form
This form is for those who wish to coordinate communication from Mr. Bartusek (last names A-Fe).
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* Indicates required question
Name?
*
Your answer
Grade?
*
9th
10th
11th
12th
Parent/Guardian
What is the topic for your appointment? Please check the box(es) appropriate
*
Academic
Career/College
Safety Issue
Other:
Required
Please provide a brief explanation so we can be ready to address your questions or concerns.
*
Your answer
Timeline for communication
*
EMERGENCY - ASAP
Urgent - within the next 2 days
Important - anytime this week
Which method would you prefer to communicate?
*
Email
Call (still figuring out, so may not be ready quite yet)
Video (still figuring out, so may not be ready quite yet)
If you prefer call or video, is there a particular time of day that works best for you?
In the morning
Around midday
Early afternoon
Clear selection
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This form was created inside of New Prague Area Schools ISD 721.
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