Family version: Lawrence student support request form

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Please use this form if you have concerns about a student and you would like one of our Social Emotional team members (Megan Ryan, Shana Shaeffer, Rhonda Flath) to follow up. We will respond during normal school hours.

Date *

YYYY

Student name *

Name of person filling out form and how you are related to the student. *

Please identify your preferred method of contact (phone, email) and list it here. *

Please describe the concern. *

Is the student already in contact on a regular basis with one of the following: *

Megan Ryan - School Psychologist

Shana Shaeffer - Jefferson Center for Mental Health (JCMH) Therapist

Rhonda Flath - Social Emotional Learning Specialist

Not sure

Required

Have you spoken with the classroom teacher about your concern? *

Yes

Other:

Submit

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