Please complete this survey ONLY if your student(s) is remote five days per week. Indicate below if you would like your student(s) to remain remote five days per week or return to in-person learning five days per week.  If you have more than one student, and you are requesting different learning options, please indicate that in the box marked "special instructions." Also, if your student(s) is returning, please indicate if transportation will be needed.

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* 1. Name

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* 2. Phone number:

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* 3. Student(s) names

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* 4. My choice for my student(s)' learning is:

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* 5. SPECIAL INSTRUCTIONS:  I am requesting different options for my students as listed below:

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* 6. If your students are returning to in-person learning, please indicate whether they will need transportation.

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