ESEA FLEXIBLE LEARNING PROGRAM SPRING STUDENT APPLICATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

January 12, 2015

Dear Parent:

Through the Elementary and Secondary Education Act of 1965 (ESEA), your child, ____________________________________, has been afforded placement for participation in the instructional Flexible Learning Program (FLP) in math for the 2014 summer term at your child’s school, Martin Luther King Jr. High. This placement is determined by federal and state Title I guidelines based upon your school being identified as a Focus school in the state of Georgia. Your child’s participation in this FREE supplemental instructional program is strictly voluntary.

You are requested to submit this completed application to the school by February 20, 2015 to Attn; Jacinth Robotham or Ms. Monica Burke, or you may fax the completed application to 678-874-5510. Should you not submit the application by deadline; your child will no longer be eligible for participation in the program.

When: January 24, & 31, February 7, 21 & 28, March 7, 21 & 28, April 18 & 25 and May 2
Time: 8:30 am to 1:00pm
Days: Saturdays
Location: Martin Luther King Jr. High

Students will be provided bus transportation, a nutritious breakfast and lunch snack. The transportation schedule will be made
available at the school. If your child participates in the program, attendance is mandatory. No more than 3 absences are allowed, and the system’s Code of Conduct rules are enforced during the program.

We value your participation in the ESEA Flexibility Learning Program. For additional information, please contact your school or Dr. Donna McBride in the Office of Federal Programs at 678.676.00332.

Student Name

Enter you child's full name as it is on the birth certificate or name change form.

Age:

How old is your child?

Gender

Is your child male or female?

male

female

Grade:

What grade is your child in?

Address:

What is your current address? Apartment #, City, and Zip Code

Current Phone Number:

What phone number you can be reached.

Alternate Phone Number

List a number that you can be reached through in the event that you current number is not accessible.

Select whether you would like your child to participate in the Federal Flexible Learning Program.

Check yes or no

yes

Parent/Guardian Name:

Please enter parent/ guardian information here.

Please enter today's date.

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.