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North High School Intervention Request Form 2024-2025
North High
CONFIDENTIAL: Please do not leave out for others to read
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* Indicates required question
Email
*
Your email
Student's First Name:
*
Nombre del Estudiante
Your answer
Student's Last Name:
*
Apellido del Estudiante
Your answer
UID: (if known)
Número de Identificación del Estudiante
Your answer
Grade
*
Freshman
Sophomore
Junior
Senior
Counselor Info- Select the student's counselor
*
Selecciona el consejero estudiantil
malia_camacho@kernhigh.org
cesilie_akins@kernhigh.org
marci_pena@kernhigh.org
alicia_vorhees@kernhigh.org
kim_hobbs@kernhigh.org
kara_doyle@kernhigh.org
dawn_godbehere@kernhigh.org
Required
Type of Concern
*
Tipo de Preocupaciones
Academic / Académicas
Behavior / conducta
Social Emotional / socioemocionales
Required
Briefly describe the reason for the request.
*
Describa brevemente el motivo de la solicitud.
Your answer
Your Name
Your answer
I am a(n):
*
Yo soy:
Choose
Parent or Guardian
Student
Self Referral
Teacher
Counselor
Community Specialist
Admin (non dean)
Support Staff
Star Support Team
Dean
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