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NRESC Wayne Valley Summer School Pre-Registration form
Last Name
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First Name
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Male or Female?
Full Address
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Parent Cell Phone
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Parent Home Phone
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Emergency Contact Name and Phone Number
Your answer
Sending School Name
Your answer
Sending School Address
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Sending School Phone Number
Your answer
Last Grade Completed
Do you receive supplemental help during the regular school year? Please check all that apply
Does the student have any additional needs for specialized or support services? (If yes, IEP/504 must be attached to registration forms)
Will your child be taking remedial courses or accelerated courses?
Course 1 (subject and grade level)
Your answer
Course 2 if applicable (subject and grade level)
Your answer
Authorization of sending school: Credit may not be awarded without the approval of the sending school. Please provide the name of the Principal/Guidance Counselor approving the course. (Note: You will need a signature of the school official in order to enroll in accelerated/remedial courses)
Your answer
Note to counselors: For students taking Algebra 1, Algebra II, Geometry, English 1, English 2, or English 3, please share the information in this document (tinyurl.com/parcctemplate) with wvsummerschool@gmail.com.
PARCC acknowledgement (Please check all to complete registraction)
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