Learning Modality Survey
Student Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
School Name
Student Grade
1st
2nd
3rh
4th
5th
6th
7th
8th
9th
10th
11th
12th
Modality of Learning
Fully Virtual
Hybrid Virtual & In-person
Home School
Other
For the Next Semester the Modality of Learning You Prefer
Full Time Virtual
Hybrid
Other
I, undersigned, agree with the following statements:
I am the parent/guardian of the student indicated above.
I understand that I am choosing how my student will attend school for the entire next semester.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: