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.
Student's First Name
Student's Last Name
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.
2020-21 Grade Level
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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This form was created inside of Highland Community Unit Schools #5.