Student Intervention Consent Form - Horizon Private School

Dear parent,

We have noticed that your child has been struggling to cope with grade-level expectations. To address this, we will be conducting an initial screening that will help us identify the specific areas that require improvement. In addition, we will be implementing targeted intervention sessions to provide additional support to help him/her show progress. These sessions will be free of charge and will be based on the results of the screening and in-class observations.

Intervention sessions will be personalized to meet your son/daughter’s needs. The sessions will be scheduled during school hours for one to two periods per week.

The intervention will include one or more of the following:

One-on-one instruction session
Small group instruction (2 students, maximum)
Additional scaffolding resources or materials

Before proceeding with the screening and intervention sessions, we kindly request your consent. Your participation in this process is crucial as it allows us to work collaboratively in the best interest of your child.

If you have any questions or concerns regarding your child’s intervention or require further clarification, please do not hesitate to contact us. We are willing to schedule a meeting with you.

Student's Name *

First

Last

Registration Number *

Student's Section *

Parent/Guardian Name *

First

Last

I, the parent of the child mentioned above *

Date *

Signature *