Please use this form to submit CONFIDENTIAL requests for:
  1. Field Trip Scholarships (available through PTSA fundraising)
  2. Classroom Supply Fee discount (available through PTSA fundraising)
  3. Grocery gift cards/food resources (available through PTSA fundraising)
  4. New clothing from the MLC Clothing Closet or PTA Clothing Center
  5. Assistance with TriMet or transportation costs
  6. Housing or Utility Assistance
  7. Substance use/drug or alcohol use concerns
  8. Grief support
  9. Culturally affirming mental health support
  10. Other needs or resources
Requests are sent directly and confidentially to MLC Support team: Clement Wilson (Social Worker), Ethan Risom (K-6 Counselor), Gretchen Benner (7x12 Counselor), & Beriah Empie (Restorative Justice Coordinator)

(Information will be also be shared with Kathleen, MLC's school secretary, when related to PTSA funded classroom supplies and field trip support)
Sign in to Google to save your progress. Learn more
Email *
Name *
Student(s) Name & Grade *
I would like to request support with … 
(check all that apply)
Briefly describe any details related to your request *
Your MLC Support team is available for students and their families. Would you like to check in with someone?
Clear selection
What is your preferred method of communication?
Clear selection
Anything else you'd like us to know?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Portland Public Schools. Report Abuse