Request for Support
This form can be filled out to request support from the PiM Counseling & Social Work Departments. **If this issue is an emergency or you feel unsafe, please go to the Resource Room if you have IEP or the front office for anyone else**
Please note that this form is only monitored during the school day (8:30-2:30 pm) when school is in session.
Please also note that your requests will be follow-up with via your PiM email during distance learning.
First and Last Name
I am a
I or my student has an IEP or 504 Plan
This request is in relation to
I want to mee with
Sarah Jane Klein (School Counselor)
Montgomery/Monty (Dir of Student Life)
Schauwitzer (Dir of Teaching and Learning)
Shelly Graf/Deb Klein (Social Worker)
Stephanie Soskin (College and Career)
I am not sure who can help
I would like this person to contact
both me and student/parent
I would like to meet with someone
Today if possible
Tomorrow is fine
Next week works
Before the end of the quarter
By email is fine
What time frame works best
8:00 am - 9:00 am
9:00 am- 10:00 am
10:00 am- 11:00 am
11:00 am- 12:00 pm
1:00 pm- 2:00 pm
2:00 pm- 3:00 pm
Any time works
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This form was created inside of PiM Arts High School.