VAST
VASSAR AFTER SCHOOL TUTORING
RETURNING SCHOLAR APPLICATION Scholar Name: _________________________________________________________________________________ First Last M.I. Grade: _______ Age: __________ Gender: _____________ Race/Ethnicity: ___________________________ Parent/Guardian 1 Name: ___________________________________________________________________________ First Last M.I. Parent/Guardian 2 Name: ___________________________________________________________________________ First Last M.I. Parent/Guardian Contact Information Home Address: _______________________________________________________________________________________ _______________________________________________________________________________________ Home Phone: _____________________________________ Cell Phone: _____________________________________ Which is better to contact? (Please circle) Home Phone Cell Phone Email Address: ________________________________________________________________________________________ Parent Occupations: __________________________________________________________________________________ What is the best day of the week and time for you to attend VAST meetings/events? _________________________________________________________________________________________________________ What language(s) do you speak at home? __________________________________________________________ Emergency Contact [ ] Please check here if emergency contact person is same as Parent/Guardian 1 above. If different from above, please write emergency contact information below: Emergency Contact Name: ___________________________________________________________________________ Relationship to Student: _____________________________________________________________________________ Emergency Contact Phone: __________________________________________________________________________ VAST
VASSAR AFTER SCHOOL TUTORING
General Permission Slip 2013-­‐2014 I, _____________________________________________________, grant my child ________________________________________ permission to participate in the Vassar After School Tutoring (VAST) program at Poughkeepsie Middle School. I give permission for my child to go on informal walking field trips in the surrounding neighborhood of the middle school under the supervision of VAST tutors and administrators. • VAST will occur on Mondays, Wednesdays, and Fridays from 2:55-­‐4:30pm. Does your child participate in other activities that may conflict with VAST? [ ] Yes [ ] No If so, what activity? (Sport, dance, school clubs, church activity, etc.) : ________________________________________________________________________________________________ Please check which days (if any) your child will NOT attend VAST because of conflict: [ ] Mondays [ ] Wednesdays [ ] Fridays PARENT/GUARDIAN SIGNATURE: _______________________________________
DATE: _______________________ Turn over to back-­‐-­‐-­‐à VAST
VASSAR AFTER SCHOOL TUTORING
Transportation Permission Slip 2013-­‐2014 How will your child get home from VAST? (Please check all acceptable choices.) o I (or another adult) will pick up my child promptly at 4:30pm from Poughkeepsie Middle School. Please write the names of any other adults (besides parents/guardians) who may pick up your child from VAST: ________________________________________________________________________________________ ________________________________________________________________________________________ o I give permission for my child to walk home. o My child will take the bus home. o Other: _________________________________________________________________________________ ________________________________________________________________________________ Please note that VAST scholars must leave or be picked up at Poughkeepsie Middle School at 4:30pm sharp. VAST will dismiss students from the main lobby. VAST cannot be responsible for students after 4:30pm. PARENT/GUARDIAN SIGNATURE: _________________________________ STUDENT NAME: _______________________________________________ DATE: ______________________ VAST
VASSAR AFTER SCHOOL TUTORING
RETURNING SCHOLAR APPLICATION For the student to fill out: What are two goals you will work to achieve in VAST this year? Be as specific as possible! 1. ____________________________________________________
_________________________________________________________________________________________________ 2. ______________________________________________________________________
________________________________________________________________________
What school subject is the most difficult for you? ______________________________
What do you want to be when you grow up? Why? _________________________________________________________________________________________________ _________________________________________________________________________________________________ Please use the space below to write one paragraph (4-­‐5 sentences) about why you want to be in VAST this year. Think about: What do you like about VAST? What are you looking forward to doing again? What do you learn from VAST? Why do you think that is important? Turn over to back-­‐à VAST
VASSAR AFTER SCHOOL TUTORING
RETURNING SCHOLAR APPLICATION For the student to fill out: Please list the academic classes you are taking this school year and your teachers’ names below. VAST might use this information to ask your teachers about what you’re learning so we can best help you with your homework. Period Course Name Teacher Name 1 2 3 4 5 6 7 8 Homeroom Homeroom