MNHHS Youth Services Center Parent Referral
Do you have a concern about your student? Do you have an issue in the household you need assistance with? Do you need help, but don't know the best way or where to start? Use this referral form and the Youth Services Center will direct your needs to the appropriate school staff for support.
What is your (parent) first and last name?
Best phone number to reach you?
What is your student's first and last name?
What grade is your student in?
Is your reason for contacting us: Academic Concerns?
Academic performance (not turning in work, failing quizzes/tests, etc)
Academic skills (time management, study skills, test-taking skills, etc.)
Other academic concerns
No academic concerns
Is your reason for contacting us: Personal issues?
Medical/Mental health issues
Social connections (problem making friends, doesn't fit in, etc)
Lack of food/necessities
Other personal issues
No personal issues
Is your reason for contacting us: Financial issues?
Assistance with job placement/opportunities
Assistance with home bills (electric, heat, etc)
Other financial issues
No financial issues
Briefly tell us more information regarding your reason for contacting us.
Would you like a follow-up contact from the MNHHS Youth Services Center staff?
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This form was created inside of Hopkins County Board of Education.