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Parent Request for Assistance (RFA) Tier II Behavior Support
Parents,
This request for assistance form is for parents & families to reach out when in need of help to manage their child's behavior in school. This program is for students that have been sent to in-school suspension (GASP), out-of-school suspension, repeated referrals to the office of Bossier Elementary for disciplinary reasons, & concerns for social & emotional development for students. Any information submitted is confidential & will be shared with PBIS Committee members only.
This request is not a request for a teacher conference, nor a request for counseling. If a teacher conference is needed, please contact the teacher directly. If counseling assistance is needed, please contact Mrs. Mitchell, 549-6359, or complete the Request for Counselor Assistance, also located on the school website.

Thank you,
PBIS Team

Email address *
Student Name (Last, First) *
Your answer
Person Making Referral: (Last Name, First) *
Your answer
Relationship to Student *
Grade *
Please select any external behaviors that you have seen your child display or that a teacher has reported to you. *
Required
Please select any internal behaviors that you have seen your child display or that a teacher has reported to you. *
Required
Please select any contributing factors that you feel have led to your child displaying any of the above behaviors. *
Required
Please list any other concerns or information you feel would be important for us to know: *
Your answer
Daytime phone number to contact you. *
Your answer
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