Request for Services for Students Attending a Non-Public School
The State of Minnesota has authorized local public school districts to loan textbooks, standardized tests, and individual instruction materials to pupils attending a non-public school that is established and operating within their local school district boundaries.  The materials must be secular in nature and designed primarily for individual use by the pupil in a particular class or program in the non-public school the pupil regularly attends. Further, the State of Minnesota has authorized local public school districts to allow pupils in secondary non-public schools access to existing district health services and secondary pupil guidance and counseling services programs.  All of these services must be requested by or on behalf of the pupil no later than Friday, September 4, 2020.
Sign in to Google to save your progress. Learn more
Name of Non-Public School:  Marshall School
Please complete the information requested below, providing the full name and grade for each Marshall student.  Click all the check boxes to indicate that you are requesting textbooks, standardized tests, and individualized instruction materials; health services; and/or counseling and guidance services for each student listed. (Only secondary students qualify for counseling and guidance services.)
Student names and grade level: *
Services Requested *
Required
Electronic Signature
I hereby verify that textbooks and individualized instruction materials requested are to be used by the pupil named above in a course of instruction at the pupils elementary or secondary school.
Parent/guardian signature *
Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Marshall School. Report Abuse
Google Forms