Parent Request for Student Mental or Behavioral Health Services
Our school district strives to promote mental health awareness and access to mental health services in our schools to increase health and wellness of students, families, and the community. Please use this form to submit requests for counseling, support, or intervention services for any student experiencing emotional or behavioral concerns.
Email address
Form1C
Date Submitted
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Select your child's school:
Student Information
Student Full Name
Your answer
Student DOB
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Student Grade Level
Student Gender
Student Race/Ethnicity
Required
Parent Requesting Services
Your Full Name
For example: Mary Jones
Your answer
Your Phone Number
Your answer
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