Bereft Students
Experiencing the death of a parent is difficult. Managing the grief associated with the death can be especially arduous when the death occurs in childhood or adolescence. Healing does not happen quickly or on
its own. An essential step toward healing is awareness. Identification of a child or adolescent whose parent or guardian has died is the first step.
The purpose of this brief survey is to identify children and adolescents in the Wyoming Valley West School District whose parent or legal guardian died. It is necessary to reply even if the death occurred in years past. Where possible, please provide the date of the death and cause of death. An indicator will be added to identified student’s biographical information in Skyward.
Future steps include education, preparation, and training to better equip educators to best handle the unique needs of students enduring the death of a parent or guardian.
Response to this survey is voluntary.

Please contact Dr. Reilley or Maylan Nicholson should you have questions:
dreilley@wvwsd.org                            maylan@wvwsd.org
570.288.6551 ext. 10702                   570.288.6551 ext. 18910
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Email *
My child(ren)'s parent or legal guardian, or sibling is deceased.  *
Please identify the deceased (Same Household): *
Date of Death
MM
/
DD
/
YYYY
Briefly state cause of death
Please list all children of the deceased who attend a school in the Wyoming Valley West School District.
I certify that the information provided is accurate to the best of my knowledge and understand that it will be used solely by the school district to provide appropriate support for my child. The information will remain confidential and shared only with school personnel who have a legitimate educational interest.   *
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