Request for Assistance
This form is used to request additional assistance for a student who is struggling to be successful behaviorally and/or academically at school. This form can be filled out by a teacher, parent, community member, or student. The concerns indicated in this form will be addressed by Hastings Middle School's Intervention Team within 2 school days. The process that follows the completion of this form could include a historical review of grades, behaviors, and other related information, as well as a team meeting to address what interventions would best fit the student's needs. You may be asked to be a part of the student's team of supportive individuals.
Your Name *
Your answer
What is your relationship with the student? *
Student Name *
Your answer
Student Grade
Does this student have an IEP or 504 Plan on file?
What is the area of concern?
Please describe the concern you are experiencing.
Your answer
What strategies have you tried in order to help the student resolve the problem?
Your answer
Check strategies you have tried
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