POLLOCK PINES ELEMENTARY SCHOOL DISTRICT DISTANCE LEARNING CRITERIA
Distance Learning Request Form. Please submit one form per student.
Student First Name *
Student Last Name *
School Attending *
Grade in 2020-2021 *
Student currently has an IEP? *
Student currently has a 504 plan? *
Parent is able to provide supervision and academic support daily? *
Student is highly motivated, independent learner and able to ask for support. *
My student has access to Internet at home *
Residence has Internet connectivity that supports video playback *
I am the legal Parent/Guardian of the above student and I understand the request will be reviewed and I will be contacted by the school with more information
Parent First Name *
Parent Last Name *
Parent email *
Contact Phone *
Submit
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