Request edit access
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. The Tier II Behavior Support program is for students who have been sent to in-school suspension (GASP), out-of-school suspension, received 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 should not be used to request a teacher conference, or for counseling. If a teacher conference is needed, please contact the teacher directly. If counseling assistance is needed, please contact our school counselor, Mrs. Mitchell, 549-6359, or complete the Request for Counselor Assistance form, also located on the school website.

Thank you,
PBIS Team
Email address *
Student Name (Last, First) *
Person Making Referral: (Last Name, First) *
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: *
Daytime phone number to contact you. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Bossier Parish Schools. Report Abuse