Field Leader Contact Form

I need help with:

Location

Select Your State

Student Information

Student Name

Student Grade

Parent/Legal Guardian's Contact Info

Parent/Guardian Name

Phone Number

Email Address

Current Program Information

Is this for a schedule change or cancellation?

Current Program

Current Schedule

MondayTuesdayWednesdayThursdayFriday

Effective Date

Program Information

Desired Program

Desired Schedule

MondayTuesdayWednesdayThursdayFriday

Desired Start Date/ Effective Date

Additional Information

Additional Family Information

Are they a new family or a current family?

New FamilyCurrent Customer

Was the family unable to register online using the parent portal?

Does the family currently receive or will apply for subsidy?

YesNoI don't know

Notes:

Drop-In, Punch Card or a Late Fee

Is this for a drop-in, punch card, or a late fee?

Date of drop-in, punch card or late fee:

Is this for before, after, or combo?

Has the family been notified of the charge?

YesNo

Program End Time

Time of Pick Up

Additional Information

Nature of concern:

Does the family need to be contacted by phone?

YesNo

Additional Comments

Discount/Scholarship

Scholarship Amount (percentage)

The Area Manager and/or Senior Program Manager need to approve this.

Program to be covered:

Duration of coverage

Discounts

Discount Type

Additional information for why there needs to be a manual adjustment:

General Assistance

What do you need assistance with?

Field Leader Contact Information

Your First Name

Your Last Name

Title

Your Email Address

Your Phone Number

RAS Employee Discount

Your current position with Right At School

Location (i.e. Central Office, or School location name)

Area Manager's Name

Please reach out to your Tech Super User for assistance. You can find your assigned Tech Super User here. Please make sure you are logged into the Wiki with your RAS email address.

Log into your Employee Self Service in Paycom. Click on "Ask Here" in the upper right hand corner.

Questions about this form?