Full Year Curriculum Waiver

Full Year Curriculum Waiver
Student's Full Name*

First NameLast Name
Student's Grade*
Name of Curriculum/Platform*
Has the student used the requested platform/vendor before?*

YesNo
Have all other curriculum needs been accounted for in the student's budget planning sheet? No additional instructional funds will be added due to poor planning.*

YesNo
Does the budget planning sheet include all necessary materials the provider requires with the curriculum, such as science lab kits, workbooks, novels, etc (those allowable with funds).*

YesNo
Have you, the learning coach, verified that all components of this curriculum match the student's curriculum needs?*

YesNo
Does the student have the necessary technology for this curriculum platform?*

YesNo
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Please select your HST from the dropdown below*
Please initial next to the statement below
I understand that there are no refunds and/or cancellations, and that no additional funds will be added to my student's account.*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Please initial next to the statement below