Initial ESY Information Gathering Form
Your name
*
First Name
Last Name
Do you have any students that might be found eligible for Extedned School Year services based on the above criteria?
*
Yes
No
Unsure
Please fill out the chart below for each student you anticipate will likely meet criteria for Extended School Year Services.
Are you interested in providing services this summer? (Check all that apply)
*
Yes; I would be interested in providing services for any eligible student.
Yes, but I am only interested in providing services for students on my caseload, or from my school.
I am not interested in providing ESY services this summer.
Other
Submit
Should be Empty: