2021-2022 Placement Input Form
Dear Parents/Guardians:

We feel parental involvement is valuable when determining what is best for a child. Specific information from
you regarding academic and behavioral needs can assist us in placing your child. We cannot, however, honor
requests for specific teachers or requests for students to be placed with specific peers.  This form is applicable for students currently enrolled in Kindergarten, 1st, and 2nd grade only.  Current third grade parents will receive a separate form to complete from Eden Hall Upper Elementary.

Thank you for taking the time to complete the question at the end of this form. We can promise your input will
be reviewed and considered. Please do not reference specific teachers or specific peers.  If you have more than one child, you will need to fill out this form separately for each child.

Please submit the completed input form no later than Friday, March 31, 2021 to ensure consideration
of your comments when making our decisions regarding placement. Thank you.

Ms. Jenna Sloan, Richland Elementary Principal and Amy Molitor, Richland School Counselor
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Please select the building that your child will attend for the 2021-2022 school year *
Last name of student *
First name of student *
Student ID number (number used to purchase lunch, okay to leave blank)
Current grade for 2020-2021 *
Projected grade for 2021-2022 School year *
School attended during the 2020-2021 school year (or at the time of completion if you transitioned throughout the year) *
What special needs (academic, behavioral, or social) does your child have, or what particular concerns do you have about your child that you would like the school staff to consider when determining your child's placement in a classroom? Please do not reference specific teachers or students. We are unable to honor requests for specific teachers or requests for students to be placed with specific peers. Thank you. *
Full name of person completing this form (Last, First), and relationship to student: *
Best phone number to contact person completing this form if clarification is needed. *
Best email address to contact person completing this form if clarification is needed. *
Please provide an electronic signature below by typing your full name to indicate that you are the person completing this form. If you are choosing to complete this optional form, remember to submit a separate form for each student. *
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