Opt Out Survey Form Winter 2022

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GRADES 3-8

If you DO NOT want your child to complete the Panorama Survey, please complete this form by Thursday, December 15, 2022.

GRADES K-2

Students in grade K-2 are not given the survey; therefore, you do not have to opt them out of participating.

You may also opt out by calling or emailing your child’s school counselor or principal.

* Required

Student Last Name *

Your answer

Student First Name *

Your answer

Student ID Number *

Your answer

Grade Level *

3

4

5

6

7

8

School *

#1 Henry Harris

#2 Vroom

#3 Robinson

#4 Mary J Donohoe

#5 Lincoln

#6 Horace Mann

#8 Midtown

#9 Washington

#10 Woodrow

#12 Bailey

#14 Oresko

Homeroom Teacher *

Your answer

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