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School Age Request for Assistance Form

For Non-Public/Private School Age Students within the Eau Claire Area School District

The first step in this process is gathering information about the student.  It is essential that you make every effort to provide detailed information in the request form (below). Please note this is not a request for special education.  This form initiates collaboration and communicates concerns to Eau Claire Area School District staff.

Student's Identifying Information

Student's Gender:
( ) -
Type of phone:

Student's School Information

Information About Person Submitting Request for Assistance

Relationship to student:

Do parent/guardians give permission for school staff to observe the student in the school setting listed above:

Information About the Student and the Concerns

This request is for concerns in the area(s) of (Check All That Apply) :


Contact Information for Person Submitting this Request

Once you have submitted your request it will be processed, and you will receive a phone call or email from the district consultant.  At that time you will receive follow-up paperwork in the mail.