Auglaize County Alternative School Intake Form 2021-2022
Date for Assignment must be confirmed by the Alternative School monitor in advance.
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Fax Number or Email for Exit Report:
Number of Days
If yes, please list any special directions.
Will student need access to a computer?
If yes, for what assignments?
Students will not be allowed to bring a jump drive from home.
Student has been told bus transportation times.
Student has been told to pack lunch or bring $2.80 for full or $.40 for reduced lunch from Wapakoneta Middl School
Student has been told no electronic devices, including cell phones and iPods, will be allowed.
Emergency Meidla form has been faxed or sent with student.
Assignment sheet has been faxed, emailed, or sent with student. (email
Student has been told to bring all needed materials.
Student Lunch Status
Reduced (Must provide free and reduce lunch form.)
Free (Must provide free and reduce lunch form.)
School Official filling out form:
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This form was created inside of Auglaize County ESC.