Extended Student Services (ESS) Request Form 
This survey will support us in planning for our ESS programs in the 23/24 school year and begin your child enrollment into the ESS program.
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Email *
What are your needs in ESS for the 23/24 school year?  *
Name of Child *
What school site does your child attend? *
What grade is your child in? *
Do you have other children in need of care? *please provide Name, School and Grade
Contact Information: Provide Parent/Guardian Name, Phone Number, Email address *
Survey Request Complete
At this time (8/16/23) our program in full and we are placing families on a waiting list. Thank you for your interest in our program and for completing the form. Once the form is received it will be processed.  Once processed you will receive an email from our ProCare student management system to complete your profile and auto bill pay set up.  You will also receive an invoice for a $25 registration fee that will need to be paid prior to services rendered. After these items have been completed and confirmed you will be emailed a start date your child can begin services.  Please let me know if you have any further questions. 
Aimee Hatfield
ESS Program Coordinator 
ahatfield@alpinschools.net
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