JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
R.I.S.E. Support Request Form
Vista High School
Confidential: Please do not leave out for others to read
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
I Am A
Yo soy
*
Parent or Guardian (Padre o Guardian)
Dean (Decano/a)
Kern High Student (Estudiante)
Self Referred (Auto Referido)
Support Staff (Personal de Apoyo)
Counselor (Consejero/a)
Community Specialist (Especialista Communitario)
Site Administrator (non dean) (Administador/a)
Teacher (Maestro/a)
Required
UID
Numero de identificacion del estudiante
*
Your answer
Student First Name
Nombre del Estudiante
*
Your answer
Student Last Name
Apellido del Esudiante
*
Your answer
Student Grade
Grado del estudiante
*
10
11
12
12+
Supporting Reasons
Tipo de Preocupacion
*
Attitude or Behavior (Actitud o Comportamiento)
Family Concerns (Precupaciones familiares)
Physical Changes (Cambios Fisicos)
Smoking and/or Drinking (Fumar o beber)
Defiant of Authority (Desafinate de la autoridad)
Harrassment of Other Students (i.e. Bullying, Stalking, Sexual) (Acoso de otras/os estudiantes)
Excessive Annoyance of Other Students (Molestia excesiva de otras/os
Fighting and/or Provoking a Fight (Pelear o provacar una pelea)
Runaway (Huyendo)
Continued Classroom Disturbance (Disturbios continuos en el aula)
Lack of Peer Interaction/isolation
Lack of social skills (Falta de habilidades sociales)
Excessive Tardies (Tardanzas excesivas)
Excessive Absences (Ausencias excesivas)
Lack of Preparation (Falta de preparacion)
Lack of Motivation (Falta de motivacion)
None
Other:
Required
Briefly Describe the reason for the request
Brevemente describa la razon para la solicitud
*
Your answer
What interventions have been provided by the requester?
¿Qué intervenciones ha proporcionado el solicitante?
*
Your answer
If you are a teacher/staff member, has parent contact been made to the parent? *Remember, the best Tier I practice is a phone call by the teacher.
Si usted es un maestro/miembro del personal, ¿se ha hecho contacto con los padres? *Recuerde, la mejor práctica de Nivel I es una llamada telefónica del maestro.
*
Yes
No
Required
If no, why?
*
Your answer
Your Name
Su Normbre
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Kern High School District.
Report Abuse
Forms
