Request for Services
Training and Consultation (TaC)
District/Charter Information
School District/Charter School:
Select Your District
Albert Gallatin Area School District
Avella Area School District
Bentworth School District
Bethlehem-Center School District
Brownsville Area School District
Burgettstown Area School District
California Area School District
Canon-McMillan School District
Carmichaels Area School District
Central Greene School District
Charleroi School District
Chartiers-Houston School District
Connellsville Area School District
Fort Cherry School District
Frazier School District
Jefferson-Morgan School District
Laurel Highlands School District
McGuffey School District
Peters Township School District
Ringgold School District
Southeastern Greene School District
Trinity Area School District
Uniontown Area School District
Washington School District
West Greene School District
Other District
____________Charter Schools______________
California Academy of Learning Charter School
IU1 Campus McMurray
IU1 Campus Waynesburg
Nonpublic School
Other District:
Contact Name:
Contact Phone:
Contact Email:
Contact Role/Title:
School Building:
Consultation Information
Type of Visit
Face to Face
Virtual
Special Accommodations
Yes
No
Area of need for consultation
Assistive Technology
Classroom Autism Support
Classroom Behavior Support
PREPaRE
Inclusive Practices
Interagency Coordination
Low Incidence
MTSS-Academics
MTSS-Behavior
Transition
BrainSTEPS
Regular Education
Special Education
Progress Monitoring
Other
How soon is this consultation requested?:
Within 2-4 weeks
Within 3-4 weeks
Within 4-6 weeks
Other
Describe the current situation:
Do not include student names or personally identifiable information (PII).
Describe the supports that are in place or attempted:
Do not include student names or personally identifiable information (PII).
Part of Corrective Action?:
Yes
No
Part of ATSI?:
Yes
No
Statement of Work Request?:
Yes
No
Authorization:
I am a district or building-level administrator authorized to make a Request for Consultation.
