Special Education Extended School Year Program Application 2019


ESY is available only to special education students who have active IEPs that indicate ESY as a service.

June 24, 2019 – July 18, 2019 (Monday thru Thursday)


No High School Credits Will Be Offered

Student Information
Bus Transportation
Pick-up Address
Drop-off Address
Emergency Information

Emergency Contacts

In case of illness, emergency or accident and parent/guardian cannot be located; the following adults are authorized to act on behalf of the parent/guardian.  (Please enter two names of local neighbors, friends, relatives, or sitters.)

Emergency Contact 1
Emergency Contact 2

In the event of an accident or other emergency when a parent is unavailable, a school representative may make arrangements as he/she considers necessary for the child to receive medical or hospital care. 

128971 » If you have a visual disability, please type the numbers two one three three into the box. Your submission will be promptly reviewed by a validation service and sent to the site administrators.
By proving you are not a machine, you help us prevent spam and keep the site secure.