20 - 21 Parent Request for School Counseling/Tier II/III Team Review
Dear Hemmerling Parents/Guardians,

Thank you so much for reaching out for support to help your student. Assessing and meeting student needs is Hemmerling Tier II/III team's highest priority, and we are so grateful that you are bringing your child's unique needs to our attention.

Hemmerling's 2020 - 2021 Tier II/III team is made up of our school's principal (Ileana Gutierrez), school counselor (Miss J), select general education (Keara Gonzales, Tabitha Ramsey) and resource teachers (Amanda Mignano), former behavior specialists or TOSA’s (Kimberly Deaton, Heather Warner, Sarah McNally), a mental health therapist (Sara De Herrera), and a school psychologist (Nicole Henderson-Smither).

The goal of the Tier II/III team is to use a team approach to identify and service students needing additional supports in academics, behavior, social/emotionally, and/or attendance in order to succeed at school. We hope to catch student needs early, brainstorm ways to assist the student in their least restrictive environment, actively monitor your students progress with new interventions in place, and actively collaborate with you and your student to measure success.

Students may be referred to the Tier II/III team via teacher, parent, student, or other school personnel request. Other data sources such as chronic tardiness or absences, test scores, student grades, low-level referrals, office discipline referrals, in school or off campus suspensions may also lead to a Tier II/III team referral.

*Please note: If your student has a current Student Study Team (SST) or an Individualized Education Program (IEP), speak with your child’s teacher or case carrier for a follow-up meeting.

If you would like to refer your student for Tier II/III team review, please fill out the confidential form below. Its contents will be held in strict confidence with the Tier II/III team members.

Requests will be followed up by a Tier II/III team member within 1 - 3 business days.

Thank you for collaborating with us to meet your students needs,

Miss J
Hemmerling School Counselor
Tier II/III PBIS Coordinator

Email address *
Name of person making referral: *
Relationship to student: *
Name of student referred (First name and last initial): *
Student Grade and Teacher *
Please check all of the following that your student has currently or has had in the past: (Check all that apply) *
Area 1: Social, emotional, or behavioral concerns that are impacting the student's education or relationships at school: (Please specify) *
Area 2: Academic concerns (please specify) *
Area 3: Attendance concerns (please specify) *
Please write the number of Low Level or Office Discipline Referrals the student has received this year (If any): *
In general, how is this student doing in terms of academics, attendance, and personal relationships at school? *
Have you or your student been in contact with your student's teacher regarding your concerns? (Check all that apply) *
What have you or your student done to try and help with your concerns? What worked? What didn't? *
What has your student's teacher done to help with your concerns? What worked? What didn't? *
What is your opinion as to why the student is not being successful at school? *
What is going well with your student? What are their strengths and interests? *
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