Five Day Face-to-Face Instruction Survey

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Complete this form to specify the method of instruction that you plan to allow your student to take part in as Sumter School District plans to transition to a five-day face-to-face instruction. Please complete this form for each student that attends Ebenezer Middle School.

Important point: After April 19th, hybrid instruction will no longer be an option. If you choose five-day face-to-face instruction and your student does not attend, they will be counted absent.

Student Last Name *

Student First Name *

Grade *

6th

7th

8th

Required

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Email Address *

Parent/Guardian Contact Number *

On April 19th, when Sumter School District returns to five-day face-to-face instruction, my child will: *

Attend in-person five-day face-to-face instruction

Remain virtual for the remainder of the 2020/2021 school year

If my child attends the in-person model, he/she will commute to school as a: *

bus rider

car rider

My child will not attend and will remain virtual for the entire semester.

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