Nestucca Valley 21st Century Community Learning Centers (NV21CCLC) 
2020/2021 School Year

We've got big plans for after school program fun and adventure this year! Even though the program will not take place in person, we will still have fun projects delivered to students through the bus route and we will be operating a homework helpline for students and families to have 1:1 support after the school day instructional hours. The after school program supports academic success, social emotional learning and family engagement.
There are additional spots to add more children at the end of the survey.
 

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* 1. Student Information

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* 2. Grade

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* 3. Student's Teacher

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* 4. Date of Birth

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* 5. Sex

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* 6. Ethnicity

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* 7. Ethnicity

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* 8. Parent/Guardian Information

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* 9. Language Spoken at Home

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* 10. Emergency Contact Information

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* 11. Additional Student Name & Date of Birth (If needed)

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* 12. Additional Student Name & Date of Birth (If needed)

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* 13. Additional Student Name & Date of Birth (If needed)

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* 14. Additional Student Name & Date of Birth (If needed)

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* 15. Additional Student Name & Date of Birth (If needed)

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* 16. I would like my student to receive help with access to the Homework Helpline 1:1 tutoring only.

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* 17. I would like my student to receive help from the Homework Helpline AND receive weekly art/activity kids delivered to my home.

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* 18. Please type your name, it represents that you acknowledge your child will be participating in the 20/21 After School Program.

0 of 18 answered
 

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