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Learner Consent Form
COVID-19
Alternative School Application
Fill out this form completely. Once submitted it will be reviewed by our Guidance Counselor and you will be contacted. All information is confidential.
Date
(*)
Calendar
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Grade
(*)
09
10
11
12
Invalid Input
Student Name
(*)
Please let us know your name.
Date of Birth
(*)
Month
01
02
03
04
05
06
07
08
09
10
11
12
/
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Invalid Input
Gender
(*)
Female
Male
Invalid Input
Street Address
(*)
Invalid Input
City
(*)
Invalid Input
State
(*)
Invalid Input
Zip
(*)
Invalid Input
Student Home Phone
(*)
Invalid Input
Student Cell Phone
Invalid Input
Student Email Address
Invalid Input
Student Lives With:
(*)
Invalid Input
Relationship to Student:
(*)
Invalid Input
Parent/Legal Guardian Name
(*)
Invalid Input
Parent Home Phone
(*)
Invalid Input
Parent Cell Phone
Invalid Input
Parent Email Address
Please let us know your email address.
Reason(s) for referral
(*)
Please let us know your message.
Are you pregnant?
(*)
No
Yes
N/A
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If so, what is your approximate due date?
Invalid Input
Do you have any children?
(*)
Invalid Input
If so, who is your child care provider?
Invalid Input
Child care provider's phone number:
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Do you work?
(*)
No
Yes
Invalid Input
If yes, where do you work?
Invalid Input
Work Phone:
(*)
Invalid Input
Please answer the following questions:
I have repeated a grade:
(*)
No
Yes
Invalid Input
What grade?
(*)
Invalid Input
I enjoy reading:
(*)
Not at all
Some
Very Much
Invalid Input
I have difficulty in school because of my reading ability:
(*)
A lot
Some
Not at all
Invalid Input
Number of hours per week I usually study outside of school:
(*)
Less than 3
3 - 9
10 or more
Invalid Input
In my opinion my present study habits are:
(*)
Poor
Fair
Good
Excellent
Invalid Input
I am doing as well in school grades as my parents expect me to:
(*)
No
Yes
Not sure
Invalid Input
I am doing as well in school grades as I expect myself to do:
(*)
No
Yes
Not Sure
Invalid Input
Graduating from high school is:
(*)
Not Important
Important
Very Important
Invalid Input
How much time outside of school do you spend with your friends?
Invalid Input
What is your favorite class or subject in school?
Invalid Input
What is your favorite hobby?
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Why do you want to go to the alternative school?
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What problems have you had in school in the past? (Check all that apply)
Anger
Attendance
Behavior
Conflict with others
Grades
Other
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Explain each of the selections above as best as you can:
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How do you think the alternative school will help you solve these problems?
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What are your plans after graduating from high school?
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How do you want your name to read on your diploma?
(*)
Invalid Input
Submit
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COVID-19 Information
Schools
South Ripley District Page
South Ripley High School
South Ripley Junior High
South Ripley Elementary
Students & Parents
Mobile App
Skyward Links
Make a Payment
Food Service Payment
Book Fee Payment
Online Payment Guide
Calendars
2022 - 2023 Calendar
2023 - 2024 Calendar
Food Service
SR Cafeteria
Summer Meals
USDA Non-Discrimination
Handouts, Forms & Info
Virtual Meet Your Teacher
High School
Junior High School
Elementary School
COVID-19 Information
SR Raider Food Pantry
Report a Bully
Report a Safety Concern
Resource Officer
Nixle
Indiana Virtual Academy
Drug Tip Hot-line
Google Mail
WeatherBug
Health & Wellness
Work Permits
AHERA Notification
Cyberbullying
Preventing
Reporting
Resources for Military Families
Technology
Academics
Indiana Dept. of Educ.
Indiana Academic Standards
Web Site
Annual Performance Report
Current K-12 Reading Plan
ISTEP Growth Results
High Ability
Testing Dates
JH Testing Dates
HS Testing Dates
Elem. Testing Dates
Special Education
Title I
McKinney-Vento
District Plan
Parent Resources
Employment
Doculivery
Doculivery Quick-Start Guide
Employment Opportunities
Substitute Teacher - Apply here
USDA Non-Discrimination
New Hire Background Checks
Your Rights Under FCRA
W-4
FMLA Request Form
Employee Rights Posting (COVID)
Employee Benefit Information
Transcripts
Parchment Student Account
3rd Party Verification Process
Parchment 3rd Party Account
Learner Consent Form
COVID-19
Mobile App
