Student Educational Background Form ( To be completed by parent / guardian )

Student Name: Student Age:
Previous school/program: Grade/level:

Has your child ever been referred, evaluated, and/or placed in a Special Education program? Yes No

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I understand that temporary grade placement will be made until all academic and special education records are received by St. Vincent de Paul School. Permanent grade placement will be made after a review of all records and evaluation of academic performance.

Parent/Guardian Name: Date

To the best of my knowledge, the information given on the previous page regarding my child’s educational background is accurate and complete. I understand that St. Vincent de Paul School does not offer Special Education Programs/Therapies/Services and, therefore, may not be able to meet my child’s special education needs.

Parent/Guardian Name: Date
 
Notes:

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Special Education Agreements

I am enrolling my child, , at St. Vincent dePaul School and I aggree to the following conditions with regards to this enrollment.

Teacher Aide:	I agree that a teacher aide is necessary for my child to be enrolled and I accept full financial responsibility for the costs occurred by St. Vincent de Paul Parish for the employment of a teacher aide in the amount of $
Grading:	I agree that my child will not be evaluated according to the regular system used by St. Vincent de Paul School personnel. Arrangements will be made with teacher(s) and the principal.
Curriculum & Diploma:	I agree that my child will not be following and completing the regular curriculum of St. Vincent de Paul School for the grade in which he/she is placed. I agree that my child will receive a Certificate of Attendance upon completion of his/her enrollment, and that he/she will not receive a diploma indicating satisfactory completion of the curriculum
Other:

  
Parent/Guardian Name: Date