Please complete all sections in direct consultation with your site health office personnel. We are only able to process individual school requests, so please complete a separate form for each site (no districtwide requests).
One Provisional Staff member per school will be assigned as soon as possible and will work until the end of the school year.
* I understand that Provisional Staff must work a minimum of 30 hours per week, with a full time (40 hour) work week preferred.
Need short term (i.e. :hearing/vision screening) or part time assistance? We want to help! Don't complete this form - instead, contact Scott Olson at scott.olson@maricopa.gov at the MRC for assistance.
To process your request, we need the following Health Office, School and District Point of Contact (POC) information.
Please NOTE: A copy of this information will be emailed to the addresses provided.
Provisional Staff Weekly Schedule:*
Our provisional staff must work a minimum of 30 hours per week, with a full time (40 hour) work week preferred. With these parameters, please complete your preferred schedule:
Days of the Week Support is Needed
You will be contacted by a School Coordinator within one week of your request.
Provisional Staff assignment order is determined by each school’s "Risk Score" which includes Title One status, minority enrollment, staff: student ratio, as well as current vaccination, outbreak and % positivity status