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EARHART'S REQUEST FOR STUDENT SUPPORT
Students and family members can request help for a student by using this form. Staff members should use Aeries to make this request.
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* Indicates required question
Email
*
Your email
Name of Student
*
Your answer
Grade Level:
*
Choose
TK
K
1
2
3
4
5
What is your name?
*
Your answer
I am requesting support in the following area(s):
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Academics
Behavior
Social-Emotional Health
Attendance
Other:
Required
Why are you making this request? Check all that apply to the student.
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Lack of work completion
Inconsistent School attendance
Withdrawn/Isolated from peers
Anxious/Worried
Basic Needs are not being met (food, shelter,clothing, hygiene)
Health Issues (vision, dental, stomach, headaches, etc.)
Often Tired
Consistently Oppositional
Consistently Inattentive
Poor impulse control or hyperactivity
Frequent Peer Conflict
Other:
Required
Expected Outcome(s)
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Please describe your goal(s) for this student and the expected outcome of this request.
Your answer
Any additional Information that will help us assess this student’s needs:
Your answer
Name of staff member you would like to reach out (if you know) and the best method and time to contact you. (for example: Please call after 5:30pm)*
*
Your answer
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