Student's First Name:

Students Last Name:

Student's date-of-birth:

Student's grade:

List any neurodiverse learning styles, special needs, learning disabilities, or mental health problems that this student has which might impact his or her participation in classes or activities.  This information will be viewable by administrators and teachers only.  

If your child has no special needs, learning disabilities or mental health problems that might impact his or her participation in class, please type NONE.

Student’s Education History: (check all that apply)

Parent’s General Educational Goals for the Student for this year:

Student’s Educational Goals (if any)

Student’s Exceptional Aptitude(s):

Student’s Area(s) of Challenge

Any ongoing Modifications or Accommodations requested:

Would you like to schedule a private consultation with a member of the ETC teacher or administration to discuss your child's specific needs and challenges?