HCUSD 5 - Quarter 3 Change in Educational Environment Request for K-12 Students
Please complete the following form if requesting a change in your K-12 student's Quarter 3 learning environment from either In-person to Remote or Remote to In-Person. This form must be completed by a parent or guardian on or before Friday, December 4, at 4:00 PM. The change in learning environment will occur at the beginning of Quarter 3 -Wednesday, January 6 and remain in effect for the entirety of Quarter 3 (ending March 12).

PLEASE COMPLETE A FORM FOR EACH CHILD IN YOUR HOUSEHOLD FOR WHOM A CHANGE IS REQUESTED.
Email address *
Student's First Name *
Student's Last Name *
I would like to change my student's Quarter 3 learning environment from.... *
My child currently has a 504 plan or an IEP. *
2020-21 Grade Level *
Building *
As a parent/guardian, I understand my choice of learning environment will remain in effect throughout Quarter 3 (Jan. 6 - March 12). *
Best phone number contact. *
Name of Parent/Guardian completing this form: *
A copy of your responses will be emailed to the address you provided.
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