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Palmyra High School Transition Form between Remote & Hybrid Instruction 2020-2021
Please complete this form to request a change in instructional models for your child. A separate form needs to be completed for each student.
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* Indicates required question
Parent Name:
*
Your answer
Parent Email:
*
Your answer
Student Name
*
Your answer
Student Grade
*
9
10
11
12
Required
I am requesting that my child transfer...
To Hybrid
To Remote
From Remote
From Hybrid
To Hybrid
To Remote
From Remote
From Hybrid
Technology (check all that apply)
*
My child has a personal device and internet access at home
My child has a school issued device and internet access at home
My does not have a device or internet access at home
Other:
Required
My child receives Special Education Services:
*
Yes
No
Please state any concerns you may have regarding the impact switching instructional models may have on your child’s services:
Your answer
PLEASE NOTE:
The building principal will review your request for compliance with Palmyra BOE Policy 1648.02 and you will be notified in writing regarding its approval status.
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