Request for Support During Distance Learning 2.0

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Please complete this form to request support (for yourself or a student). The intent of this form is to is identify and respond to observed student needs as soon as possible.

THE PROCESS:
Once you finish the request, you will receive a confirmation "receipt" via email that the form was successfully submitted.

At the same time, Miss Franklin will receive an email alert of your request. Miss Franklin will review the form and respond to the request.

IN WHAT KINDS OF SITUATIONS CAN SUPPORT BE PROVIDED?
Needs can include technology issues, attendance, basic needs, academic or mental health concerns, to name a few.

If you are concerned about a student's learning or well-being, REACH OUT FOR SUPPORT!

Email *

Your Name and Role (Jane Doe, teacher, gr. 4) *

Student Name *

Student CIF *

Student's Grade *

Does the student have siblings at this school or another SPPS school? If "yes" and you know their name(s) and grade(s), please note them below. If you are unsure about siblings, write "unknown" below.

Urgency Level of this Request *

Not urgent - a one-day follow-up timeline is just fine

Mildly urgent - resolution by the end of the day would be fantastic!

Very urgent - I would love it if someone could email or call me within two hours!

Other:

Brief description of concern: *

What kind of support are you seeking? (select all that apply) *

Attendance Issues; Student has had multiple unexcused absences.

Student may be homeless (includes doubled up with friends or family) or there are other basic needs..

Student is attending, but has not submitted assignments.

Social emotional or mental health concerns

Student may benefit from an academic check in

Information and/or support for me.

Other:

Required

What actions have you already taken to address this concern?

What have the outcomes of those actions been?

Other information or unique circumstances that the Social Worker should be aware of?

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