TEXTBOOKS, STANDARDIZED TESTS and INDIVIDUALIZED INSTRUCTIONAL MATERIALS

HEALTH SERVICES 

SECONDARY GUIDANCE/COUNSELING SERVICES

Request Form For Students Attending A Nonpublic School ~ School Year Ending June 2023

The State of Minnesota has authorized local public school districts to loan textbooks, standardized tests, and individualized instructional materials to pupils attending a nonpublic school that is established and operating within their local school district boundaries.  The materials must be secular in nature, and designed primarily for individual use by the pupil in a particular class or program in the nonpublic school the pupil regularly attends. Further, the State of Minnesota has authorized local public school districts to allow pupils in secondary nonpublic schools access to the existing  district Health Services and Secondary Pupil Guidance and Counseling Services programs.  All of these services must be requested by or on behalf of the pupil no later than September 8.

Name of Nonpublic School:   STELLA MARIS ACADEMY

Please complete the information requested below, providing your family name and full name and grade of each student. Place an “X” in the appropriate boxes next to the grade column to indicate whether or not you are requesting Textbooks, Standardized Tests and Individualized Instructional Materials, Health Services, or Counseling and Guidance Service for each student listed. Reminder, only 7th through 12th grade students qualify for Counseling/Guidance services.

I hereby verify that the textbooks and individualized instructional materials requested are to be used by the pupil named above in a course of instruction in that pupil’s elementary or secondary school.