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.
What is your relationship with the student?
Does this student have an IEP or 504 Plan on file?
What is the area of concern?
Please describe the concern you are experiencing.
What strategies have you tried in order to help the student resolve the problem?
Check strategies you have tried
Reviewed historical data
Talk with parent
Talk with teacher
Seek help from peers
Change seating assignment
Provided a quiet place to work
Change schedule of activities
Give reminders of expected behaviors
Clarify rules and expectations
Rewards for expected behavior
Office Discipline Referral
Loss of privileges
Meeting with parents/ teacher
Never submit passwords through Google Forms.
This form was created inside of Hastings Area School System.
Terms of Service