EmailMeForm
Student Request for Support
If you need to speak and/or meet with a member from the Support Team, please complete the form below. A Support Team member will reach out in person or by email to acknowledge your request.
Name
*
First
Last
Email
*
How urgent is your request?
*
Low (I would like to see someone sometime this week.)
Moderate (I would like to see someone by the end of today.)
Please select the Support Staff Member you would like to see.
*
Mrs. Landis for Mental Health and Counseling Support
Mrs. Stryker for Mental Health and Counseling Support
Ms. Scott for Academic Support
Mrs. Yeager for Academic Support
Nurse Brown for Medical Support
Mr. Cooke for Behavioral Support
Mrs. Hohman
Any Member of the Support Team
Reason for request
*
Sad
Angry
Anxious/Nervous
Worried/Scared
Family Concerns
Bullying
Self-Injury
Suicidal Ideation
Other
Please give a brief description explaining your request for support.
Have you shared your request or concern with any other adult in the building? If yes, please list who.
