WMS: REQUEST FOR STUDENT SUPPORT (COST)

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Students and family members can request help for a student by using this form. (Staff members should use Aeries to make this request.)

After submitting this form, expect a staff member from your school to contact you within one week.

Email *

I am requesting support for...

(Please enter the students FULL name)

Grade Level: *

What is your name? *

I am requesting support in the following area(s): *

Academics

Behavior

Social-Emotional Health

Attendance

Other:

Required

Why are you making this request? Check all that apply to the student. *

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Withdrawn/Isolated from peers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.)

Needs support with technology or online learning

Often Tired

Possible substance use

Consistently Oppositional

Consistently Inattentive

Poor impulse control or hyperactivity

Frequent Peer Conflict

Other:

Required

Expected Outcome(s) *

Please describe your goal(s) for this student and the expected outcome of this request.

Any additional Information that will help us assess this student’s needs:

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)* *

Submit

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