Focus Group Interest for Return-to-Learn Plan

As District leaders develop the Return-to-Learn plan, feedback from staff and parents/guardians will help inform the decision-making process. By submitting this form, you are indicating your interest to participate in a parent/guardian focus group. Once submissions have been gathered, you will be contacted with further details, including date(s) and time(s).

Parent/Guardian Name: *

Phone Number: *

Email Address: *

Please indicate the days of the week and/or times of the day when you generally have the best availability. *

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Student Information

	First Name	Last Name
Student 1	First Name	Last Name
Student 2	First Name	Last Name
Student 3	First Name	Last Name
Student 4	First Name	Last Name

Student School and Grade

	School		Grade
Student 1
Student 2
Student 3
Student 4

NON-DISCRIMINATION STATEMENT:

The Sioux City Community School District offers career and technical programs in the following areas: Business & Marketing, Family & Consumer Science, Health Science, and Industrial Arts, Technology, & PLTW.

The Sioux City Community School District is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, genetic information (for employment), national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status (for employment) in its educational programs and its employment practices. The District is required by Title IX and 34 CFR Part 106 not to discriminate on the basis of sex in its programs, activities, or employment.

Inquiries or grievances under Section 504 and Title II of the Americans with Disabilities Act may be directed to Dr. Dora Jung, Director of Student Services & Equity Education/Title IX Coordinator at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, jungd@live.siouxcityschools.com. Inquiries about the application of Title IX and its regulations to the District may be referred to the Title IX Coordinator, the Assistant Secretary of the U.S. Department of Education, or both. Please see District Board policies 103 and 504.4 for additional information on available grievance procedures.