Remote Learning Coach Needs Assessment

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Parent name

Best Email address for parent

Student grade in 2020/2021 school year

Why would you like to choose remote learning for your child?

For the upcoming school year, would your child be placed in a group of students supervised, in your own home, or monitored remotely?

Placed in a home, supervised

Supervised in our own home, with other similar students

Supervised in our home with brothers and sisters

Remotely monitored by a learning coach

Other:

Clear selection

Does your child have an IEP, 504, or a learning need that needs to be addressed during the year?

Is your student, or someone in your family, immunocompromised or at risk of catching COVID?

Yes

Clear selection

Are there any unique needs that your student or family is hoping to be addressed during the upcoming school year?

Are you willing to have your name, location, and student grade shared with other families who are looking to build pods of their own?

Submit

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