Learning Model Change Request for Quarter 4
Please complete this form only if you would like to your child to return to in-person instruction for Quarter 4 from the full-remote option.

Please remember that those who elected to change to remote learning when the district returned to 5-day, in-person instruction (February 1st, 2021) selected remote learning through the end of this year, May 27th, 2021 and are not eligible to return to in-peson learning at this time.

**If you want your child to remain in the same model as Quarter 3 (full-remote or in-person) you do not need to complete this request--your child will remain in the current placement.**

If you have more than one child at school for whom you would like to change the learning model to return to in-peson learning, please complete one request for each child.

This form must be submitted by 3 pm on March 5th.
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Student First Name *
Student Last Name *
Student Grade Level 20/21 *
Does the student currently have an Individualized Education Plan (IEP) or a 504 plan? *
Parent Last Name *
Parent First Name *
Parent Email Address *
Please share any other information that you believe will be important to the in-person learning request.
Certification: I am requesting in-person learning for my child for Quarter 4.  I understand that in-person learning may have the potential to expose my child to infections.  I also understand that I am requesting in-person learning for the entire quarter. *
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