ELA Afterschool Application - PK-8 (2024-2025)

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ELAP + S2

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ELA Afterschool Student Application

Please fill out this application carefully and double check to ensure that all information provided is accurate and correct (including spelling).

KQ Campus:*

Participant's Name*

First MI Last Optional: Jr., etc.

Family History with Knowledge Quest

Please provide all information about previous enrollment or participation that this child or other family members have had with Knowledge Quest programming.

Returning student?*

If yes, when?*

Have sibling(s) enrolled in KQ?*

When did siblings attend?*

Parent/Guardian Consent to participate in Student Survey

The Tennessee Department of Education partners with the University of Tennessee Social Work Office of Research and Public Service to evaluate extended learning programs funded by Nita M. Lowery 21st Century Community Learning Centers /Lottery for Education Afterschool Programs grants. Part of that evaluation includes a survey for students in grades 3-12. The survey is anonymous: your child will not be asked to provide their name when they complete the survey. The survey asks about your child’s experience of the extended learning program and their response will support continued high-quality programming. The survey can be reviewed at TNELAP.org/UserNews. Please indicate below if you consent to have your child participate in the survey.

Parental Consent*

I consent to have my child participate in the Student Survey

I do not consent to have my child participate in the Student Survey

Explanation: The Tennessee Department of Education partners with the University of Tennessee Social Work Office of Research and Public Service to evaluate extended learning programs funded by Nita M. Lowery 21st Century Community Learning Centers /Lottery for Education Afterschool Programs grants. Part of that evaluation includes a survey for students in grades 3-12. The survey is anonymous: your child will not be asked to provide their name when they complete the survey. The survey asks about your child’s experience of the extended learning program and their response will support continued high-quality programming. The survey can be reviewed at TNELAP.org/UserNews. Please indicate below if you consent to have your child participate in the survey.

School Information Consent*

I have read the consent below and give permission to Knowledge Quest to have access to the records, information, or data of my student to be used solely for the purposes stated below.

As a participant in Knowledge Quest's Extended Learning Academy programming, your child receives education support services designed to ensure students succeed academically. This program is monitored through the Tennessee Department of Education. As such, it is vital that KQ has access to your student's records. As a part of program enrollment, Knowledge Quest requests written access to information about a student that is connected to a student's identity, including demographic information, grades, test scores, progress reports, attendance records, discipline records, student ID number, and registration records.

The Family Education Rights and Privacy Act (FERPA) protects students and parents by prohibiting most third parties, including Knowledge Quest, from accessing student records, information, or data without written permission from a parent or guardian if the student is under 18.

The purpose for accessing or sharing education records, information, or data related to your student is to better provide education support services and meet the reporting requirements set forth by the Department of Education. No records, information, or data will be used for any other purpose than those of service differentiation or improvement and reporting.

By consenting below, you are giving written permission for education records, information, or data about your student to be shared with Knowledge Quest. This information may come directly from the school, Memphis-Shelby County School District, or through partnership with Seeding Success.

Records and information from records will not be shared or given to anyone other than the parties mentioned above.

You have the right to revoke this consent at any time if you do not want records, information, or data shared, or if you do not believe the sharing of records, information, or data is in the best interest of your student. You also have the right to obtain copies of any information about your student that is shared as a result of this form. Should you wish to revoke this consent, you must provide to Knowledge Quest written notice of your decision to revoke. Unless and until this revocation is made, this consent shall remain in effect until your student turns 18.

Signature

Parent/Guardian Name

Relationship to Student

Date*

Previous School Year- Final Report Card

Accepted file types: jpg, pdf, Max. file size: 100 MB.

Please upload a PDF or picture (must be clear and show entire page) of the student's final report card from last school year (2023-2024). This must be submitted before your student can begin attending programming.

Who is your Family Coach?*

https://s1k.4b6.myftpupload.com/programs/family-stability-initiative/register/

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Second Choice

Third Choice

ELA Afterschool Application- PK-8 (2024-2025)