Request

****If this is an emergency (you or someone else may be hurt), see an adult NOW and let them know****

If not an emergency, complete form below to sign in (if SS Staff is available) or for them to get back to you as soon as possible.

Student Name Student Name First Last
Student ID#
Select the service you need:

Sign In/Out
- When seeing a Student Services Staff Member in person (if available)

OR

Complete Student Services Request
- When needing support for: Schedule Change request, Test Support-ACT/SAT/CLT, Extended School Day/Year, Personal, etc).

Select the service you need: Sign In/Out - When seeing a Student Services Staff Member in person (if available) OR Complete Student Services Request - When needing support for: Schedule Change request, Test Support-ACT/SAT/CLT, Extended School Day/Year, Personal, etc). SIGN IN/SIGN OUT (IN PERSON) COMPLETE STUDENT SERVICES REQUEST
Who are you requesting to see:

Who are you requesting to see: Mrs. Kendall (Counselor A-K) Ms. Ruconich (Counselor L-Z) Mr. Szymanski (Career Specialist) Mr. Knowles (Social Worker) Mrs. Tabacchi (ELL IA) Ms. Loveless (SSS) Mrs. Kupczyk (Gifted Resource)
Email
- provide email if you would like to communicate through a different email other than the student PCS email
Reason/Request

Reason/Request Credit Recovery/Edmentum On-Line Course ACT Waiver (11/12 grade ONLY) SAT Waiver (11/12 grade ONLY) - https://satsuite.collegeboard.org/sat/registration/fee-waivers ACT info needed - See ACTStudent.org SAT info needed - See Collegeboard.org CLT info needed Extended School Day (ESD) Extended School Year (ESY)/Summer School Schedule/Class Concern (complete fields below too) Personal Other
For Schedule/Class Concern, select from choices below to help us understand the issue:

For Schedule/Class Concern, select from choices below to help us understand the issue: I have been placed in a course I do not meet the pre-requisite for. I have been placed in a course and believe I meet the requirements to be in a higher level (ie. Honors). I already took a course and need to be switched into a different course. Other:
Provide summary with details below:
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