1.Please provide the following Contact Information

Guardian Name

Students (First Name only)

Guardian Email Address

Guardian Phone Number

2.Understanding the direction of the Re-Opening Learning Plan recommendations, will your child/ren be returning as a USD 235 student for the 20-21 school year?

A draft copy of this plan can be found at www.uniontown235.org

Yes 

No

3.If you answered yes to the above question, please answer the following for each for your students.  Which of the available learning options would be your choice?

Grade

Learning Model Choice

Student 1

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 2

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 3

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 4

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 5

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 6

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

Student 7

PKK1st2nd3rd4th5th6th7th8th9th10th11th12th

In-PersonRemote

4.If you are choosing Remote Learning, please complete the following question regarding your internet connection.  How would describe your connection at home?

I have reliable wireless internet

I have access to wireless internet but it isn't always reliable

I only have access to internet via a cell phone

I do not have wireless internet

*5.How many of your students would ride the school bus?(Required.)

0

1

2

3

4

5

6

7

Other (please specify)