* Blue Packet - Parent/Guardian to Sign

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Please take a minute to read the form. Click Next or use the Circles to navigate!
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Parent Signature:
Clear
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Please click Next or use the Circles to navigate through the packet!
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Parent Signature:
Clear
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Please take a minute to read the form. Click Next or use the Circles to navigate through the packet!
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Image Field
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Please take a minute to read the form. Click Next and you will be able to type and also input a signature which will be added to this PDF!
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Parent Full Name
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Student Full Name
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Parent Signature
Clear
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Date:
Date
Month
Day
Year
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Please take a minute to read the form. Click Next and you will be able to type your responses to each question!
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Student's Full Name:
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Student's DOB
Date
Month
Day
Year
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Parent's Full Name:
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What are your child's strengths?
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What, if any, behavior problems are a concern for you?
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What is your best guess as to why your child experience problems in school and how do you or other family members respond?
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Is there anything you need (resources) as a parent/guardian?
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On a scale of 1-10, with 10 being the best how would you rate your relationship with your child?
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Please take a minute to read the form. Click Next and you will be able to type your responses to each question!
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What do you want most for your child?
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On a scale of 1 - 5, what is your parental involvement at your student's school? 1 being the lowest and 5 being the highest.
1 I am not involved in my child's school
2 I only come to school as the need arises: misconduct, attendance, illness, etc.
3 I come for special events/programs
4 I attend PTA Monthly meetings
5 I participate at all meetings and events
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Please take a minute to read the form. Click Next and you will be able to type and also input a signature which will be added to this PDF!
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Student Full Name:
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School you are applying to. Please write LIBERATION DIPLOMA PLUS
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Signature of Parent/Guardian (if Student is under 18):
Clear
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Date:
Date
Month
Day
Year
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Address of Parent/Guardian:
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Signature of Student (if 18 or over):
Clear
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Date:
Date
Month
Day
Year
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Address of Student:
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Tags
Todo
In Progress
Done
Should be Empty: