PJUSD Request for Support (non-emergency)

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The Pierce District is committed to providing resources for students and parents who feel they are in need of support. If parents of students need additional support, from help with housing to mental health resources, please fill out the following form and the counselor from your site will contact you. This form is for non-emergency situations.

First Name: *

Last Name: *

I am a *

Parent/Guardian

Student

Family Member

Other:

My school is *

I need help with: *

Housing/Shelter

Food Resources

Mental Health Resources for Myself

Mental Health Resources for My Student

Other Resources Not Listed

If Other Resources Not Listed is Needed, Please explain: *

How would you prefer to be contacted? *

Phone

Email Address *

Telephone Number: *

Preferred Language: *

English

Spanish

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