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.
* Required
Email address
*
Your email
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
I would like to change my student's Quarter 3 learning environment from....
*
In-person to Remote
Remote to In-Person
My child currently has a 504 plan or an IEP.
*
504 Plan
IEP
Neither
2020-21 Grade Level
*
Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Building
*
Choose
Alhambra Primary
Grantfork Elementary
Highland Primary
Highland Elementary
Highland Middle
Highland High
As a parent/guardian, I understand my choice of learning environment will remain in effect throughout Quarter 3 (Jan. 6 - March 12).
*
Agree
Best phone number contact.
*
Your answer
Name of Parent/Guardian completing this form:
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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