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NRESC Wayne Valley Summer School Pre-Registration form
Last Name
Your answer
First Name
Your answer
Male or Female?
Male
Female
Full Address
Your answer
Parent Cell Phone
Your answer
Parent Home Phone
Your answer
Emergency Contact Name and Phone Number
Your answer
Sending School Name
Your answer
Sending School Address
Your answer
Sending School Phone Number
Your answer
Last Grade Completed
8
9
10
11
12
Do you receive supplemental help during the regular school year? Please check all that apply
ESL
HSPA
Tutor
Other:
Does the student have any additional needs for specialized or support services? (If yes, IEP/504 must be attached to registration forms)
Yes
No
Will your child be taking remedial courses or accelerated courses?
Remedial
Accelerated
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)
My guidance counselor knows I am taking a math course (Algebra 1, Algebra 2, or Geometry) or english course (English 1, English 2, or English 3)
I understand that I will need to take the PARCC in order to complete the program and earn a grade for the course
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