2025 - 2026 Request to See a Nurse
Please fill this form out and the nurse will call you to the Clinic when appropriate. 

NOTE: More serious illnesses/injuries are called to the clinic as priority over others in some cases. Thank you for your understanding.

** You MUST see your teacher if you are feeling VERY ill or SERIOUSLY injured.**
Email *
Student's School Email (lastname_firstname@student.mahoningctc.com) *
Last Name (legal name) *
First Name (legal name) *
School *
Required
If you are an 11th or 12th grader, what lab are you enrolled in?  
** If you're in STEM, choose Valley STEM **
 *
Required
What TEACHER (name) are you with right now? 
(DO NOT WRITE "English")
 *
What TEACHER (name) do you have NEXT?
(DO NOT WRITE "Science")
 *
BRIEFLY describe what the main reason is to see a Nurse.   *
Submit
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