Auglaize County Alternative School Intake Form
(Date for assignment must be confirmed by the Alternative School monitor in advance)
Number of days assigned:
Reason for assignment:
If yes, please list any special directions.
Will student need access to a computer?
If yes, what assignment will technology be used for?
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 the Wapakoneta Middle School.
Student has been told that no electronic devices (including cell phones and iPods will be allowed).
Emergency Medical form has been faxed or sent with student.
Assignment sheet has been faxed or sent with student.
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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