The Pro-Vision Academy Instructional Model Change Form

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If you would like to change your student's instructional model for the 4th six week period, please complete this form. Your selection is binding for the period beginning January 22, 2021 and ending March 3, 2021.

Your email address

Preferred Phone Number

Student's Last Name *

Student's First Name *

Student's Grade *

Student's 1st Period Teacher

I want to change my student's instructional model *

to VIRTUAL for the next 6 weeks

to TRADITIONAL/FACE-TO-FACE for the next 6 weeks

If you chose Face-to-Face, what will be your mode of transportation? Check only One *

School Bus

Car Rider

Walker

Required

If you are requesting bus transportation, what is your full street address

Zip Code

Option 1

Clear selection

I understand that

I cannot change my commitment once the six weeks begins.

My student's attendance/participation is required, regardless of the instructional model.

If I selected the virtual model, I must complete a technology request form if my student does not have a laptop to complete virtual work.

If my student does not participate/ make satisfactory progress, he/she will be retained and/or will not pass the course.

Option 5

Submit

Clear form

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