Teacher/Staff Request for Assistance Form - (At-Risk Screener Form)

  • Teachers/Staff/Administrators: Fill out this form for a student you determine may need a Tier 2 intervention for support with one or more of the school-wide expectations of Be Respectful, Responsible, or Safe outside of the typical SAEBRS window timeline.

    Your responses to the questions on the form are based on your interactions/experience with the student in the last 30 days.

    A member of the Tier 2 team member will reach out to you with confirmation of receipt and any next steps. A Tier 2 Team may be composed of the following members: Administrator, Intervention Counselor, MTSS-B Counselor, Academic Teachers, Intervention teachers, School Psychologist, and Nurse.

    Click HERE to access the form.