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Please fill out this form separately for each child that would be affected by this proposed takeover by the CVUSD and then click the [Submit Application] button located below the form to send the information to us. Once we receive your information, one of the SCARED parent volunteers will contact you ASAP.

Thank you for your interest in joining our group. We look forward to working with you.

Note: items marked with a (*) are mandatory.

Parent's Name/Nombre de Padre(*):


 Last/Apellido :


 First/Nombre:
Student's Name/Nombre de Estudiante(*):


 Last/Apellido :


 First/Nombre:

Address/Domicilio(*): 		Street/Calle:
City/Ciudad:
State/Estado: Zip Code/Area Postal:
Email ID/Identificacion de Correo Electronico(*):
Telephone/Telefono(*):
School/Escuela(*):
Teacher/Maestra(Maestro):
Age/Edad de Estudiante(*):
 Grade Level/Grado:
Disability Type/Tipo de incapacidad(*):
Years with County?/Anos con el Condado?
Years with District?/Anos con el Distrito?

When did you find out that Chino Valley District wanted to take over the county's special education programs?
Cuando fue que usted se entero de que el Distrito del Valle de Chino queria tomar control del las clases de educacion special del condado?
 

What has been your experience with the county/district since your child has been in the special education programs?
Cual ha sido su experiencia con el condado o el distrito desde que su hijo(hija) ha estado en el programa de educacion especial?
 

Comments/Comentarios:
 


Please CAREFULLY VERIFY all the information you have entered before you press the [Submit Application] button!