Transition to Hybrid Learning Request Form

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This form should only be filled out by parents/guardians that wish to transition their child from the Virtual Only Instructional Model to the Hybrid Instructional Model (which includes in-person instruction 2 days a week). Parents/guardians should fill out a separate request form for each of their children.

Student's LAST Name: *

Student's FIRST Name: *

Which school does your child currently attend? *

Mary F. Janvier School

Main Road School

Caroline L. Reutter School

Student Grade in 2020-2021 School Year: *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Pre-K

Does your child currently have an Individualized Education Plan (IEP) and receive special education services? *

Yes

Transportation-Please select one of the following choices below. If your child needs transportation on some days but not others, please select the first option. *

My child will need to take the bus on the two in-person instructional days per week

I will provide alternate transportation for my child to and from school (only select this option if your child will not be riding the bus at all)

Parent/Guardian Name: *

Parent/Guardian Email Address: *

In completing this request your child will be reassigned from the Virtual Only Instructional Model to the Hybrid Instructional Model and requires your child to attend in-person instruction two days per week. Please review and acknowledge an understanding of the following before submitting: *Parents/guardians do not need to wait until October 1, 2020 to submit this request. *All requests will be honored but will be addressed on a first come, first serve basis. *Due to the complexity of scheduling, transportation limitations, and the individual needs of the student, placement may take up to two weeks to complete. *Only 1 instructional model change per trimester will be permitted. *A change from virtual only learning to hybrid/in-person instruction will likely result in a change in the student's schedule and teacher. *

Yes, I acknowledge the information provided in the form and am requesting that my child be placed into the Hybrid/in-person instructional model.

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