Needs-Based Questionnaire

Let us know how we can help!

South County Middle School is committed to ensuring that all our students have the resources and support they need throughout the school year to reach their full potential in school and within the community. The questionnaire below is entirely optional and confidential. You only need to complete and return the questionnaire if you are interested in receiving assistance to address the needs below. If you have any questions about this form, please contact Ms. Jennifer Payne, our Director of Student Services, at [email protected] or 703-690-5500.

Student Grade Level
What is the best way to reach you?

What area of assistance can we help you with? Please check the types of assistance you’d be interested in learning more about, if available. Check all that apply.

Please know that Fairfax County Coordinated Services Planning is a resource for any family in Fairfax County. They are ready to help you through an assessment by phone to identify the needs you have and link you to resources for which you are eligible. This can include providing basic county information or assisting with more urgent needs such as emergency food, shelter, clothing, healthcare, employment, financial assistance and other essential needs. You can reach Coordinated Services Planning at 703-222-0880, TTY 711 Monday through Friday, 8 a.m. to 4:30 p.m. If you need assistance with your rent, in addition to calling Coordinated Services Planning, you can find more information on the Emergency Rental Assistance program by visiting the Fairfax County Eviction Prevention Website.