Alpha Intent to Return Form 2021 - 2022
Please complete and submit Google Form by Friday, March 19th so that we may begin the process of preparing your child’s educational plan for next year. Providing your intent now helps ensure that we complete your student’s online course scheduling prior to the start of the 2021-22 school year.
Student's First Name
Student's Last Name
Student's Current Grade (20-21 school year)
Student's Guidance Counselor
Jane Foor - 7th grade
Kristine Johnston - 8th and 9th grade
Shain Hosterman - 8th and 9th grade
Stefanie Gilbert - 10th ,11th, and 12th grade
Bridget Kennington - 10th ,11th, and 12th grade
Elizabeth Girts - 10th ,11th, and 12th grade
Student's Academic Coach at Alpha
Student's Current Address
Phone Number 1
Phone Number 2
Please check the appropriate box below indicating your scheduling intention for next school year.
Student is returning full-time to MCHS/MCJHS for the 2021-2022 school year.
Student would like to return to Alpha for some or all classes for the 2021-22 school year.
The applicant and parent(s)/guardian must read the following to indicate that they understand and agree to these terms:
We wish to re-enroll our child in the Alpha Program for the upcoming school year. We understand that, having made the choice to re-apply to the Alpha program, we are committing ourselves to work with the Alpha community (staff, parents, and students) and we must commit time to help with our student’s education. We also understand that if the applicant does not assume responsibility to meet the expectations of the program, the staff may decide that the student must transfer from the program to his/her originating school.
Our completion of this form indicates permission either for our child to re-enroll in the Alpha Program or our intent to return to MCHS/MCJH for the 2021-22 school year.
Send me a copy of my responses.
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This form was created inside of Mifflin County School District.