Specific Needs Request Form
This form is due by Thursday, Feb. 20th, 2024 or sooner!

Thank you for taking the time to complete this form; it enables us to provide a safer and more enjoyable experience for your students.

Please list ALL students who may need support (even minimally). If your student typically has an aide in the classroom, it is important for that student to have the same support at Outdoor School. Please check with your administration about sending the aide to Outdoor School. The OSU Extension service will reimburse schools / districts for extra duty pay and / or overnight stipends for aides. I will also do my best to recruit and schedule my very limited pool of adult volunteers to help your students as requested. 

Please list any social emotional needs, anxiety, mental health issues, behavior concerns, physical challenges or impairments, developmental delays, learning challenges, and any students who use adaptive equipment. Do not list allergies or dietary concerns, those will be included on the Health History form the parents fill out.

If you would like to include the student's IEP, feeding protocol or 504 accommodations please email those documents to kboryer@mesd.k12.or.us after you complete this form.

If you have no students who need special assistance, you only need to complete Page 1 of this form or email me at kboryer@mesd.k12.or.us and I will take you off my list.

Kitty Boryer
Student Services Specialist
(503) 257-1607

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Email *
Session *
Week Attending *
Outdoor School Site *
Name of School *
Name of teacher(s) attending Outdoor School with class *
School Phone Number *
Best day / time to reach you? *
Are you bringing any students with specific needs with you to Outdoor School? *
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