REACH

                                           Application Form

Please return to Lola Shock

_______________________________________                                                     ______

Student Name                                                                                                             Grade

_______________________________________

Parent or Guardian Name

________________________________________________________________________

Address                                                                                                                        Zip

______________________________                        ______________________________

Home Phone                                                                Work Phone

______________________________             

Cell Phone

_______________________________________

Email Address

REACH OFFERINGS for 2006 – 2007

REACH Grade Level Support:

Students receive the same college preparatory curriculum within the same classrooms as

every other Harding student while receiving core-subject support from the REACH

teacher.  Parents receive communication by email daily for 7th and 8th grade students and

as needed for 9th – 12th grade students.

REACH 4:1 Math Class (ESP):

Students learn the same curriculum and earn the same credit as in regular math classes

but receive more individualized attention in the REACH math class with a

student/teacher ratio of 4:1.

Enroll the above student in the following REACH offering(s):

(Please circle your selection/ selections)

Grade Level Support:        7              8              9              10              11              12

4:1 Math Class:        PreAlgebra              Algebra I              Algebra II              Geometry

I understand that signing this form does not guarantee a place in the REACH program: however,

as soon as my student’s placement is finalized, I will receive, sign, and return the contract

addendum.

                                                                       _____________________________________

                                                                                         Parent Signature