After School Education and Safety (ASES) Program Request Form for 2021-2022
The After School Education and Safety (ASES) program provides FREE quality before- and after-school academic and enrichment opportunities for middle school students at Mesa Verde Middle School.  As the district continues to plan for the safe reopening of the ASES program on school campuses and address the needs of middle school families for in-person supervision of students, please assist us by completing this form.

All information on this form will be confidential.  This is NOT a registration form.  This is a request to be considered for priority enrollment in the ASES program as it transitions back to an on-campus program model.  

Students who are interested in the ASES program for the 2021-2022 school year MUST complete this survey.  Availability of the in-person ASES program will be limited. Priority for enrollment of students will be based on the following considerations:

1. Students experiencing homelessness or foster youth, as defined by the federal McKinney-Vento Homeless
Assistance Act (as required by CA Education Code)
2. Students who qualify for the Free or Reduced Meal Program
3. Students who attend every day and remain in the program for the full duration of program hours.

This request form does NOT constitute acceptance into the ASES program.  This is NOT a registration form. You will be contacted directly by your school's ASES Supervisor to receive information for completing the registration process for the in-person ASES program when a date is confirmed for the program to relaunch at MVMS.

Please fill out a separate survey for each middle school student in your family.

If you have any questions about this form, please contact Christine Carrera, Assistant Director for Preschool & Before/After School Programs at (858) 521-2850.

***Note: Our Before School (AM) program is currently full.  If you are interested in the Before School program, you will be placed on a waitlist and contacted only when a space is available.
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Email *
Parent first and last name *
Student first and last name *
PUSD student ID number
Consideration for priority enrollment is being requested based on the following criteria (check all that apply) *
Required
For which program(s) do you anticipate having a need? *
Required
What is the anticipated need for Before School program services? *
No Before School needed
6:30am
before 6:45am
before 7:00am
before 7:15am
before 7:30am
before 8:00am
Monday
Tuesday
Wednesday
Thursday
Friday
What is the anticipated need for the After School program? *
No After School Program needed
Until 3:00pm
Until 3:30pm
Until 4:00pm
Until 4:30pm
Until 5:00pm
Until 5:30pm
Until 6:00pm
Until 6:15pm
Monday
Tuesday
Wednesday
Thursday
Friday
2021-2022 Grade level *
Does this student have a sibling(s) also interested in attending the ASES program? Please fill out a separate survey for each student. *
Please confirm that you understand that this is an ASES Program Request survey.  This is NOT a registration form.  Your school's ASES Supervisor will contact you regarding next steps.  Thank you for completing this survey. *
Required
A copy of your responses will be emailed to the address you provided.
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