After School Education and Safety (ASES) Program Request Survey for BMMS New & Returning students
All information on this form will be confidential.  This is NOT a registration form.  This is an ASES request to register for the ASES Program.  Students who are interested in the ASES program for the 2020-2021 school year MUST complete this survey.  First priority enrollment into ASES will be given to students who are identified as foster or homeless youth, as defined by the federal McKinney-Vento Homeless Assistance Act.  Second priority will be given to students that can attend 5 days a week and the latest check out time. We would like this survey filled out by March 31, 2020. This request form does NOT constitute acceptance into the ASES program. This is NOT a registration form.  Please fill out a separate survey for each child in your family attending Black Mountain Middle School.

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Email *
Parent first and last name *
Student first and last name *
Please check if your student will attend before or after school program *
Required
2020-2021 Grade level *
Required
For the before school program, what time will the student usually be arriving?
6:00 AM
6:15 AM
6:30 AM
6:45 AM
7:00 AM
7:15 AM
Monday
Tuesday
Wednesday
Thursdy
Friday
For the after school program, what time will your student usually be leaving? *
4:15 - 4:29 PM
4:30 - 4:44 PM
4:45 - 4:59 PM
5:00 - 5:14 PM
5:15 - 5:29 PM
After 5:30 PM
Monday
Tuesday
Wednesday
Thursday
Friday
Does this student have a sibling(s) attending the ASES program? Please fill out a separate survey for each student enrolling in 2020-21 BMMS ASES. *
Is one parent/guardian currently active military?   *
All information on this form will be confidential.  This is NOT a registration form.  This is a ASES request to register for the ASES Program.  Students who are interested in the ASES program for the 2020-2021 school year MUST complete this survey.  First priority enrollment into ASES will be given to students who are identified as foster or homeless youth, as defined by the federal McKinney-Vento Homeless Assistance Act.  Second priority will be given to students that can attend the full program time daily.    This request form does NOT constitute acceptance into the ASES program.  This is NOT a registration form.  Please fill out a separate survey for each child in your family.
Please understand that this is an ASES Program Request survey.  This is NOT a registration form.  We will contact you directly with the next steps once the survey window has closed and we begin enrollment.  Thank you for completing this survey. *
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