Rivercrest Elementary School Parent Concern Form
Please complete this form if you have concerns regarding your student's academic performance, behavior, or social-emotional well-being.
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Email *
Section 1 - Parent/Guardian Information
Parent/Guardian Name (First and Last) *
Relationship to Student *
If you responded 'other' on the previous question, please explain below. 
Preferred Phone Number *
Preferred Method of Contact *
Student Information
Student's Full Name *
Student's Grade Level *
Teacher's Name *
What type of concern are you contacting us about? *
Required
Section 3: Academic Concern
What academic area are you most concerned about?
Please describe your concern.
When did you first notice this concern?
Clear selection
How often are you noticing this concern?
Clear selection
Has your child received any support for this concern from a source outside of school?
Clear selection
Is there any medical or health information we need to know about that would affect your child's academic performance (examples: current diagnoses, medication, removal of medication, etc.)?
Section 4: Behavior/Social-Emotional Concern
What type of concern are you noticing?
Clear selection
Please describe what you are noticing?
When did you first notice this concern?
Clear selection
How often are you noticing this concern?
Clear selection
Has your child received any support for this concern from a source outside of school?
Clear selection
Are there any specific triggers you have noticed?
Is there any medical or health information we need to know about that would affect your child's behavior (examples: current diagnoses, medication, removal of medication, etc.)?
Section 5: Speech/Language/Communication Concerns
What type of communication concern are you noticing?
Clear selection
Please describe your concern.
When did you first notice this concern?
Clear selection
Has your child previously received speech/language/communication services?
Clear selection
Section 7: Miscellaneous Information
What have you already tried at home to address your concern?
Please provide any information you believe would help us better support your child at school or anything else you would like us to know.
A copy of your responses will be emailed to the address you provided.
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