RHS Support Request Form:
Please use this form to refer a student for Intervention and Support Services. Information will be kept confidential.
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I am a :
Student's Grade Level
Rebekah Ames (A-Bt & all IT Academy Students)
Elia Negrete (ELL Students)
Claire Miller (Bu-Fo)
Ashley Gonzales (Fp-Joh)
Lauren Figueroa (Joi-M)
Salvador Garcia (N-R)
Mindy Munoz (S-Z)
Academic Concerns (check all that apply):
Grade of "F" in more than two classes
Excessive tardies/absencses (not engaged in online courses on a daily basis)
Refuses to do homework
Lack of preparation
Lack of motivation
Defiant to teacher
Social-Emotional/Behavioral Concerns (check all that apply):
Attitude or behavior
Substance abuse (alcohol, tobacco, or drugs)
Defiant of authority
Harassment of other students
Fighting and/or provoking a fight
Mental Health Concerns (please explain):
Briefly explain the reason for request:
Have other interventions/supports been offered and/or implemented ? Please explain:
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Kern High School District.