Student Needs Assessment

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Dear McClure Parents,
We appreciate your time filling out this form to assess your child's needs for the school year. It helps us to identify the needs our students have as resources become available. We are excited to hear your responses and provide resources for your family. Sincerely, Your Mental Health Team

Student Name *

Parent/Guardian Name *

Phone Number *

Teacher

Backpack

Yes

Clear selection

School Supplies

Yes

Clear selection

What school supplies are needed?

Winter Coat

Yes

Clear selection

Coat Size

Harvesters Backsnack Program (bi-weekly bag of food)

Yes

Clear selection

Medical Supports

Yes

Clear selection

I would like a social worker or counselor to call me to discuss my child's education needs.

Yes

Clear selection

Space to provide more info

Submit

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