MEAD OPTIONS INTEREST FORM (one form per student)
Please take the time to fill out the form below.  When an appropriate opening becomes available within the program selected, we will contact you with further. information
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Email *
STUDENT LAST NAME: *
STUDENT FIRST NAME: *
Student's DATE OF BIRTH:  MM/DD/YYYY *
Enrollment requested for... *
GRADE: Which grade will your student be in chronologically, for the year of enrollment? (unrelated to academic achievement or credits) *
PARENTS; Name(s) *
Parent email *
Parent cell phone *
OVERVIEW OF MEAD OPTIONS PROGRAMS: Please read about the programs below before continuing.
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Please carefully consider the choices above, and indicate which program you are interested in for your student? (Some programs may be currently full or have a waiting list.) *
What brings you to the Mead Learning Option program you have selected? *
Current school(s) (or homeschool) *
Additional previous schools and districts (list all) *
Do you live within the Mead School District? *
EXPERIENCE: Do you have any experience with the type of learning program you selected above? Please explain. *
ADULT AVAILABILITY: Will there be an adult home during the school day for instruction or supervision of instruction?  Please explain. *
GRADES: How are your student's grades in the current school. *
SUPPORT: Does your child need specific support(s) in an academic, health or behavioral area? Please explain. *
IEP: Does your child have an active IEP (Special Education Services)? *
504: Does your child have/need a 504 Plan (specific learning or support accommodations are in place)? *
ELL: Does your child have/need English Language Support (English is not the child's first language)? *
HEALTH PLAN: Does your child have/need a health plan? *
We will be contacting your previous school(s), is there anything we need to know?   *
I authorize all previous/current schools my child has attended to the release of the following information: IEP records; 504 records; discipline records and attendance records to the selected Options Program(s) in the Mead School District, for the purpose of evaluating a student's application for enrollment. *
Required
I further authorize the staff of our previous/current school to speak with the staff of the Mead Options program(s) selected, regarding my student’s experience at the current/previous school. *
Required
I understand the Prohibition on Re-Disclosure: This information has been disclosed to the named individual(s) from records whose confidentiality is protected by Federal Law. Federal Regulations (FERPA and ADA) prohibits making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general Authorization for the release of medical or other information is not sufficient for this purpose. *
Required
In accordance with FERPA, I, the parent of the student listed above, hereby authorize the previous/current school(s)  to release information from the student’s education record to the staff of the Mead Options Program(s) for the reasons specified. I acknowledge by my signature that I understand, that although I am not required to release my information, I am giving my consent to do so. Additionally, I understand that I may revoke this authorization in writing at any time, except for that information which has already been released with consent and prior to my revocation. *
Required
SIGNATURE and DATE for authorization for release of confidential information. *
I understand that every the Mead Learning Options program is a public school of choice that operates under the mandates of Washington State law governing Alternative Learning Experience (ALE) programs.  It is NOT an entitlement and is NOT independent homeschooling. These programs do not currently have transportation.

Enrollment is based on a parent's ability to be an active partner in their child's education and abide by the ALE laws.
* A written student learning plan (WSLP) is set up for each student that outlines the course, curriculum materials and acceptable progress.
* Families can access an extensive library of district and building approved materials.
* No Mead Options Programs can purchase or supervise the use of any curriculum/materials that are faith-based.
* During the 30 hours of instruction covered by the WSLP, only approved curriculum may be used.
 *
Do you have any questions? *
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