Parks Junior High - Request for Assistance

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This form is to be utilized for requesting assistance at Parks Junior High School for academic, behavioral, and/or social-emotional concerns for a particular student. The form below may be completed by a family member or a student at Parks Junior High.

This form is only available electronically.

The Request for Assistance form will be submitted to the principal, assistant principal, and school counselor who will communicate with the PBIS Team to determine best interventions that will support the student.

Student First Name, Last Name *

Student ID # *

Date *

YYYY

Grade *

I am a (choose one): *

Family Member

Student

Name of person filling out the form: *

Relationship to student: *

Type of concern (Check all that apply): *

Academic

Behavior

Social-Emotional

Required

Please describe in detail the type of concern stated above: *

Submit

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