Student Services
Request for Discussion, Coaching, and Training
Please read through the expectations of all parties when co-op student services are utilized
here
.
Initial below verifying you've read the Student Services Expectations.
*
INFORMATION ABOUT THE CLASSROOM / TEACHER:
Grades Taught
*
K
1
2
3
4
5
6
7
8
9
10
11
12
School Corporation
*
Please Select
Cannelton
Greater Jasper Consolidated
North Spencer County
Northeast Dubois County
Perry Central
Pike County
South Spencer County
Southeast Dubois County
Southwest Dubois County
Tell City - Troy
School
*
Teacher's Name
*
First Name
Last Name
Teacher's Email
*
example@example.com
Type of Classroom
*
Resource Room
Co-Teaching
Self-Contained
Lifeskills
Other
Behavior Consultant's Name
*
First Name
Last Name
Behavior Consultant's Email
*
example@example.com
INFORMATION ABOUT SUPPORT STAFF
Principal's Name
*
First Name
Last Name
Principal's Email
*
example@example.com
Diagnostician's Name
*
First Name
Last Name
Diagnostician's Email
*
example@example.com
TYPE OF CONSULTATION NEEDED
*
organization support
special education programming
support / creation or feedback on schedules (staff and students)
managing assistants
efficient use of time / staff
universal design for learning
use of visuals
communication needs
work systems (TEACCH, task boxes)
data collection and documentation
use of behavior consultant
how to access resources
IEP implementation (systems)
specially designed instruction outline
provisions
progress monitoring systems
IEP preparation
writing goals
physical classroom set up
classroom choreography
Best Time to Meet
*
Please Select
Before School
After School
Lunch
Planning Period
Background information of the main issue
*
(I.e. safety concerns, target student names, class to student ratio,
Upload Master Classroom Schedule here.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
YOUR Name
*
First Name
Last Name
Your email
*
example@example.com
Submit
Should be Empty: