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SY 20-21 GARFIELD VIRTUAL HOME VISIT SHEET
We will use the following information to determine what partners we need on campus and in our community.
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* Indicates required question
Email
*
Your email
Name of Student (Last, First)
*
Your answer
Name of Parent (Last, First)
*
Your answer
Phone #
*
Your answer
Email address of parent
*
Your answer
Grab N Go meals through APS are distributed at area high schools on Mondays for the whole week
*
we will pick up a weeks worth of meals for each student in our house
someone else will be picking up meals for our students
we would like to participate but don't have transportation
we would like to participate but don't have adequate storage
we will not be picking up breakfast/lunch boxes on Mondays
What is your preferred language for communication?
*
English
Spanish
Other:
Date of visit
*
MM
/
DD
/
YYYY
What is your preferred method of communication? Check all that apply and update in Synergy if there are changes.
*
E-mail
Text messaging
Phone call
Written communications like letters, flyers, notes or memos
Required
Does your student have any of the following special accommodations?
*
IEP
504 Plan
Health Plan
mental health or emotional wellbeing needs which we should know about
none of the above
Other:
Required
Have you set aside a place in your home where your student can focus on school and learning at home?
Yes
No
Clear selection
Have you seen or heard about the APS Re-entry Plan? The plan can be viewed at
https://www.aps.edu/schools/reentry-plan
Please call the school if you have any questions about this plan. We can be reached at 344-1647
*
Yes
No
How is your family coping with the COVID restrictions? Is there anything the school can do to help?
*
Your answer
If APS requires changes due to COVID or if someone tests positive and the school must be closed for sanitation, what can we do to make the transition easier for your family?
Your answer
Expanded and Enriched Learning Opportunities - Do you or your family need help with the following? Check all that apply:
*
Learning how to use or to support online learning at home
Homework or tutoring help for your student
Adult Technology Basics
Internet Access
Translation services
I don't need any of these services at this time
Required
Integrated Student & Family Support - Does your family need referrals for any of the following types of support services? Please check of all that apply
*
food
school clothes
school supplies
Housing
Utilities
transportation
dental
health
vision
legal services
mental or behavioral health
finding a job / or better job
Translation services during communication and engagement at school
We don't need any referrals for these services at this time
Required
Family & Community Engagement - Would you or your family like to help the school in any of the following ways? Check any that apply:
*
Campus Clean up
Staff Morale and Appreciation
Grab and Go distributions as needed including food pantry help
I have a volunteer background check and would like to help
I would like to help but I need help to pay for a background check
I am not available or interested in helping at this time
Required
Collaborative Leadership - Would you or your family like to support Garfield by participating on a Leadership Team? Check any that apply:
*
Community School Council
Instructional Council
Other groups that are formed as needed
I'm not available or interested in serving at this time
We appreciate you taking the time to visit with us. Is there anything else we should know in order to provide your family with the best education possible this school year?
*
Your answer
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