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Student/Parent/Guardian Request for Assistance - PAWS
Parents and students are encouraged and applauded for recognizing a need for intervention with academics and behavior. Complete this form to request assistance.
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* Indicates required question
Student's Name
*
Your answer
I am a:
*
Student
Parent
Other
If not a student, please provide your name and relationship to student:
*
Your answer
Grade
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T9
9
10
11
12
1st block Teacher
*
Your answer
Does student have an Individualized Educational Program (IEP?)
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Yes
No
Don't know
Does student have an Individualized Accommodation plan (IAP?)
*
Yes
No
Don't know
Type of Concern:
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Academic (failing one or more courses)
Behavior (multiple behavior referrals)
Both Academic and Behavior
Social/Emotional Concerns
Briefly describe the reason for request:
*
Your answer
How can we contact you? (please leave preferred method of contact and information- i.e, email, phone number, etc.)
*
Your answer
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