JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Waitlist Request for In-Person or Online Changes
Please complete one form for each child you are making a request for. THIS FORM ONLY NEEDS TO BE COMPLETED IF YOU ARE REQUESTING A CHANGE FROM THE OCTOBER SURVEY.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Grade
*
TK/K
1st
2nd
3rd
4th
5th
6th
I want my student to be placed on the following waitlist:
*
Hybrid IN-PERSON Instruction (4 days in person on campus AM or PM, Wednesday Online)
ONLINE Instruction (4 days online AM or PM, Wednesday Online)
Bell Schedule as of November 30th
Name of the parent/guardian filling out this survey.
*
Your answer
Comments or Additional Information you would like Jefferson Admin to know.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Clovis Unified School District.
Report Abuse
Forms
