Parental Request to Retain Student 2021-22 School Year
Please take the time to fill out this form to request an SBLC meeting with teachers and administrators to request that your child be held back (retained) in his or her current grade.
There are multiple reasons that parents may want their children to repeat a grade: academic, social/emotional maturity, etc. Please be sure and list the reasons on this form. There is no guarantee that your child will be retained in their current grade level, but our SBLC committee will review each request and you will be contacted regarding this submission.

Please submit this form by April 1, 2021.
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Email *
Student First Name *
Student Last Name *
Student's Current Grade Level (2019-20) *
Has your child been retained in a previous grade? *
Student's Date of Birth *
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/
DD
/
YYYY
Parent's Name *
Parent's Phone Number *
Please list reasons for your interest in retaining your child. *
A copy of your responses will be emailed to the address you provided.
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