Student Needs

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Student Needs

We would like to provide additional supports to students. Help us identify our next move by providing truthful answers below.

Email *

Name

I would schedule medical visits, such as urgent care, if the school provided services on-site. *

Yes

I need transportation for my child's Medical Care, Optical Care, and/or Dental Care

Yes

Clear selection

I would like to learn more about mental health. *

Yes

I feel like I need support with information regarding substance use for myself or someone I know. *

Yes

I am a parent or expectant parent *

Yes

I am interested in planning for post-secondary options *

I don't have a plan yet

Required

Transportation to school *

My family drives me to school

Other:

If the school provided bus transportation I would ride the bus to school. *

Yes

A school bus stop convenient to me would be at these cross streets: 10014 2nd st nw

I am interested in signing up for Driver's Ed

Yes

Clear selection

My living situation is: *

I live with my parents

Other

Have you or your family members received an eviction notice in the last few months? *

Yes

My family has enough food at home *

Yes

I would like a referral to the clothing bank (You will receive socks, under garments, light jacket, voucher for shoes) *

Yes

I need support with laundry *

Yes

I am looking for employment *

Yes

Other

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of HYPERTEC USA INC.

Does this form look suspicious? Report

Forms