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Community School Coordinator Parent/Guardian Student Resources Form
If you feel that your family is in need or could benefit from some resources please feel free to complete as much or as little of this form as possible and I will reach out to you either with more information or to gather a bit more information in order to best support your family.
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What is the best way to contact you?
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Call
Text
Email
Required
Please enter your contact information (whichever form of contact your prefer)
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Your answer
Student: Last Name, First Name
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Your answer
Parent/Guardian Name: Last Name, First Name
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Your answer
Are their multiple students in the home? (List other students names and school attending)
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Your answer
Are there preschool aged children in the home? (Age 3-4)
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Yes
No
Do you have any questions/concerns about your students grades/credits? (if yes, I will refer you to our school counselor)
Yes
No
Clear selection
Do you have any questions/concerns about your students attendance? ( If yes, I will refer you to our school counselor)
Yes
No
Clear selection
As a Community School Coordinator there are some school based resources I am able to refer your student to, if you are interested:
After School Program Referral (YMCA, Youth Impact, Tutoring)
ChAT referral (Attendance, Behavior, Low Academics)
Social Worker Referral
School Counselor Referral
Preschool Referral
Parent/Guardian is not interested in any school based referrals at this time
Any additional school based resource referral not listed above:
Your answer
Ogden School District also provides short term immediate assistance to our students and families through MarketStar Student Resource Center as well as additional resources with community partners, please let me know if you are interested in any of the following? (MarketStar Resource Center, KIND Fund, and RIC must go through the CSC so please do not reach out to them on your own. I am happy to provide you with more information about them and reach out to them on your behalf.)
MarketStar Resource Center (immediate needs for food, clothing, school supplies, diapers, formula, toiletries, etc..)
KIND Fund (clothing)
Resource Integration Coach (RIC’s to assist in long term community assistance/referrals for assistance)
Additional Support Service (Community Christmas, Parenting Elevated, Summer Bridge, etc…)
Parent/Guardian is not interested in any school based referrals at this time.
Any additional community based resource referral not listed above:
Your answer
Ogden School District understands for a student to be successful our families need the resources to be safe and healthy. Our district partners with many community resources and we would like to know if there are any challenges you may be facing that we may be able to help with or help connect you with one of our partnered community resources?
Food Assistance (Immediate and/or long term needs)
Housing (including assistance paying for rent or mortgage payment)
Utilities (electricity, water, internet access, or phone)
Transportation
Resources for School
Resources for Dental Care
Resources for Vision Care
Resources for Medical Care
No, Family does not need resources at this time.
Family, chooses not to answer.
Other:
If "Other" resource referral is needed please list below:
Your answer
Additional Notes: If there is anything else you would like the school's administration to know about your student please include it here.
Your answer
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