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#
Is the Student Services staff available at this time?

Is the Student Services staff available at this time? YES, SIGN IN/SIGN OUT NO, COMPLETE SS REQUEST
Email
- provide email if you would like to communicate through a different email other than the student PCS email
Who are you requesting to see:

Who are you requesting to see: Mrs. Kendall (Counselor A-K) Ms. Ruconich (Counselor L-Z) Mr. Knowles (Social Worker) Mrs. Tabacchi (ELL IA) Ms. Ruthruff (SSS) Mrs. Kupczyk (Gifted Resource)
Reason/Request

Reason/Request Credit Recovery/Edmentum On-Line Course Approval 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 Personal Other 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: Other:
Provide summary with details below: