2024 ESY Application
Dear Parents/Guardians;

The Special Education Extended School Year Program will operate 5 days a week.

All Grade Levels (Preschool - 12th grade)        June 11 - June 28, 2024
Mercey Springs Elementary School                   8:00 am - 11:30 am
                                                                                 June 19, 2024 is a holiday

If you wish to have your child attend the extended school year (ESY) session, please complete all the information below by April 15, 2024. It is important for your child to attend the entire ESY session to ensure adequate instructional time to receive educational benefit.

If you have any questions or need assistance understanding this letter, please contact the Special Services Department at (209) 827-0120.

Claudine Gutierrez
Coordinator of Special Services
Los Banos Unified School District
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Student's Current Teacher *
Student Name *
Student Date of Birth *
DD
.
MM
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ÅÅÅÅ
Address, City, Zip Code *
Home Phone/Cell Phone *
Email Address *
Emergency Contact/Phone Number *
NAME AND PHONE NUMBER OF ADULT WHO MAY BE CONTACTED IF PARENT CANNOT BE REACHED. 
Transportation *
ALL STUDENTS WILL BE DROPPED OFF AT THEIR HOME. 
PARENT OR DESIGNATED ADULT MUST BE PRESENT TO MEET THE BUS EACH DAY
IF SPECIAL CIRCUMSTANCES ARE REQUIRED, PLEASE INDICATE IN THE NEXT BOX.
Transportation - Special Circumstance
If none applies, leave blank
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