Parent Input Intervention Form
Please use this form if you would like to provide additional information for your student's intervention
Your Student's First and Last Name *
Your Student's OLCHS ID#
Your First and Last Name *
Are you the student's parent/legal guardian?
Clear selection
Please list some of your student's strengths.
Please check all areas of concern you have
Please describe what persistent struggles you see your student having:
Please check any OLCHS staff member you have contacted with your concern *
If your student is receiving outside assistance please let us know:
Please list anything you have done at home that has helped your student succeed (i.e. removed distractions while studying)
If you have any other comments, recommendations, or questions, please feel free to add them here.
What is the best way to reach you? Please include your phone number or email address.
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