Student Support Services Request for Contact
Please complete this form to receive a contact from the student services team in your building. Examples of support services include maintaining social-emotional health and wellbeing during this time of restricted social interaction, mental health management, behavioral concerns, substance use, coordination with community based mental health providers, basic needs, and academic struggles.  

Support services will be provided starting March 30, 2020. Requests will be monitored daily during regular school hours M-F. All submissions are confidential and will be routed to building specific contacts by Student Services leadership.

Please note: if this is a mental health emergency, please call:
Dakota County Crisis at 952-891-7171
Scott County Crisis at 952-818-3702
Local law enforcement at 911  
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Email *
Today's Date
Student Name
Parent Name
Primary Phone
Primary Email
Building Attended:
Grade:
Which staff member would you like to connect with from your building? (if applicable)
Optional: Please describe your concern or need. If this is a mental health emergency, please call Dakota County Crisis at 952-891-7171 or 911.
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