9-12 P.A.L. APPLICATION:

Parent Assisted Learning

9000 NE West Kingston Road, Kingston, WA 98346

Directions:

For students not currently enrolled in NKSD:
  • Fill out application in your own handwriting
  • Return your application, North Kitsap School District registration forms, and immunization records to the PAL Registrar
  • Counselor will contact you to schedule an interview
  • If you have any questions, please contact 360-396-3404
/ For students currently attending NKSD:
  • Fill out application in your own handwriting
  • Return your application to your neighborhood high school Counselor who will attach a current credit evaluation and forward it to the PAL program counselor
  • The PAL Counselor will contact you to schedule an interview

Name: ______Date: ______

Birthdate:______Class of:______Address: ______

City:______, State:______, Zip:______

Phone:______Cell:______E-mail (print):______

Who do you live with?______

Parent or legal guardian name(s):______

Are you enrolled in school now? Yes No

If yes, where:______If no, where/where did you last attend? ______

How many credits have you earned?______

Are you interested in participating in PAL: Part-time Full-time

What classes are you interested in taking through PAL?

How would the PAL program meet your needs? ______

What has been the best thing about school for you? a.) Academically, b.) Personally ______

9/23/2012

What has been the hardest thing about school? a.) Academically b.) Personally

What are some of your interests?

Who will support you, outside the PAL staff, to be successful in the program if you are accepted? ______

______

Describe your education/career goals:

Do you have any schedule conflicts Mon-Fri 8AM-2:30PM? Yes No

If yes, please explain:

Do you have your own transportation? Yes No

How do you get to and from school?

Are you employed? Yes No Where:______How many hours/week?

Student Signature:______Date:______

Family/Parent Signature:______Date:______

Counselor/Admin Signature:______Date:______

PAL Application

Parent / Guardian – Questionnaire

Student’s Name ______

Your child is expected to spend at least five hours per week for each subject in which he/she is enrolled. As a result, your support and supervision are essential for your child’s success. Please thoughtfully consider and respond to the following questions:

Describe three qualities your student possesses that would make him/her successful in the PAL Program:

1)______

2)______

3)______

What would you like us to know about your student’s educational background or unique needs that would distinguish him/her from other PAL applicants?

______

In what ways will you provide the following?

Support:______

Supervision: ______

Additional academic assistance: ______

Transportation:

______

Parent/Guardian Signature: ______Date: ______