2021 Hillside Middle School Summer Program

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Please use this form to register your child for Hillside's Middle School Summer Program. The afternoon program is for students entering sixth through ninth grade in Fall 2021. After completing the form, you will receive a confirmation email and an invoice for the total cost of the program.

Summer Details:
June 7-25
12:00 - 3:00, Monday through Friday
$975 for one module
$1800 for two modules
$75 assessment for non-Hillside Students

Email *

Reading Modules: Please choose only one. Reading modules will be offered from 12:00 - 1:20 for students entering 6th and 7th grades in August, and from 1:40 - 3:00 for students entering 8th and 9th grades in August. *

Reading: An emphasis on comprehension and retention through effective note-taking strategies and assistive technology.

Advanced decoding skills: Focusing on attacking multi-syllable words, exploring morphology, and reading fluency.

I do not want to sign up for a reading module.

Required

Writing and Math Modules: Please choose only one. Writing and Math modules will be offered from 12:00 - 1:20 for students entering 8th and 9th grades in August, and from 1:40 - 3:00 for students entering 6th and 7th grades in August. *

Writing: Learning the methods of organizing and creating an expository essay

Math: Focusing on number sense and fluency skill to strengthen the mathematical base for higher-level math concepts

I do not want to sign up for a math or writing module.

Student Name *

Date of Birth *

YYYY

Student's CURRENT Grade in School *

Current School of Attendance *

Gender *

Parent Contact Name *

Parent Contact Email *

Parent Contact Mobile Phone Number *

Second Parent Contact Name

Second Parent Contact Email

Second Parent Contact Moblie Phone Number

Describe your child's strengths, interests, and hobbies *

Describe your child's social relationships *

Academic Areas of Concern (check all that apply) *

difficulty with decoding

difficulty with reading fluency

difficulty with reading comprehension

difficulty with spelling

difficulty with handwriting

difficulty with written language

difficulty with writing fluency

difficulty with math fact fluency

difficulty understanding math concepts

difficulty with performing mathematical calculations

difficulty maintaining attention

difficulty with organization

difficulty with expressive language

Other:

Required

What services has your child received? *

IEP - Individualized Education Program

504 Plan

Private Tutor

Private Assessment (Learning Evaluation, Psycho-educational Evaluation, Neuropsychological Evaluation)

Psychological Counseling

Other:

Required

Health Conditions and Diagnoses *

Please list any medications your child is currently prescribed. *

How does your child respond to frustration? *

Describe your child's attention and behavior at school. *

Is there anything else we should know about your child?

I understand that the full tuition of $975 for one module and $1800 for two modules is due upon acceptance into the summer program. Tuition will be refundable minus an administrative fee of $150 if cancellation is received before March 19, 2021, after which time, tuition will only be refunded if the vacated space can be filled. *

Yes

Students not currently enrolled at Hillside who register for the Advanced Decoding class may also need to come in for a brief initial assessment to determine their current skill levels within the context of Hillside's academic program. There is an assessment fee of $75. *

My child is currently enrolled at Hillside and will not need the assessment.

My child is not a current Hillside student and will need the $75 assessment.

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