Student Support Request
Teacher/Tutor First Name
Teacher/Tutor Last Name
Class #
Student First Name
Student Last Name
How the student alerted you to this need:
In Person
Call
Email
Text Conversation
Virtual (Zoom, Google Meet)
Student Email Address
Student Phone Number
Student's Preferred Language
Please select...
Spanish
French/Haitian
English
Other
Date of Request
Did the student want to express interest in an IET training program (CNA, Food Handling, Entrepreneurship, Paraprofessional/Substitute Teaching or Forklift)?
Yes
No
Which program is the student interested in?
CNA
Food Handling
Entrepreneurship
Forklift
Paraprofessional/Substitute Teaching
Non-Academic Barrier Support Needed by Student
Housing
Healthcare
Resume Assistance
Rent
Dental Care
Job Search or Application Assistance
Utilities
Mental Health
Career Exploration
Food
Vision Exam/Glasses
College Guidance
Transportation
Obtaining ID
Training Support
Childcare
Digital Skills
Other
CAN DO Assistance
Toiletries or Other Supplies
What other support does the student need?
Urgency of Need
High (Emergency)
Normal
Low
Notes
Contact Information
Literacy KC
300 E 39th St. | Kansas City, MO 64111
www.literacykc.org
|
info@literacykc.org
main: (816) 333-9332 | fax: (816) 444-6628