Information for Parents Summer Learning Place 2014
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Information for Parents
Summer Learning Place 2014
Furman University
WHAT IT IS:
• A four-week (15 days, Monday through Thursday) comprehensive, small group instructional
program for children/youth ages 6-14 with learning difficulties
• Curriculum includes academics, social skills, and physical activities
• Taught by graduate level teachers certifying in special education
• Note: Enrollment is limited to a 4-to-1 student-teacher ratio
WHEN IT IS:
• July 8-31, 8:30 a.m.- 11:30 a.m. (Monday through Thursday)
Please note: The first day of the program will be Tuesday, July 8.
• Students may arrive at 8:15 a.m. or later. There is no supervision prior to that time. Students
must be picked up by 11:30 a.m.
WHERE IT IS:
• Location: Sevier Middle School, 1000 Piedmont Park Road, Greenville, SC 29609
COST:
• The charge to each student who attends is $150.00 (payable to Furman University; $50 due
with application form and the remainder due by June 29)
WHAT YOU CAN EXPECT:
• Evaluation of your child's specific learning abilities in academics, learning styles, and
personal/social behaviors at the beginning of the program
• Assessment of progress made during the program and a final report which may be shared with
your child's school
• Creative teaching and learning opportunities for your child
• Ongoing communication with your child's Summer Learning Place teacher
FOR MORE INFORMATION:
Contact Director Pat Hensley at 864-979-2232, patricia.hensley@furman.edu
WHAT YOU NEED TO DO:
Spaces are limited and fill quickly! We encourage you to apply as soon as possible.
Please submit the completed information forms with a $50 deposit, and
send to:
Erikah Haavie, Summer Learning Place, Furman University Education Department,
3300 Poinsett Highway, Greenville, SC 29613 or via e-mail to erikah.haavie@furman.edu
Information for Teachers
Summer Learning Place 2014
Furman University
WHAT IT IS:
• A four-week (15 days, Monday through Thursday) comprehensive, small group
instructional program for children/youth ages 6-14 with learning difficulties
• Curriculum includes academics, social skills, and physical activities
• Taught by graduate level teachers certifying in special education
• Note: Enrollment is limited to a 4-to-1 student-teacher ratio
WHEN IT IS:
• July 8-31, 8:30 a.m.-11:30 a.m. (Monday through Thursday)
(Please note: The first day of the program will be Tuesday, July 8)
WHERE IT IS:
• Location: Sevier Middle School, 1000 Piedmont Park Road, Greenville, SC 29609
COST:
• The charge to each student who attends is $150.00 (payable to Furman University; $50
due with application form and the remainder due by June 29)
WHAT YOU CAN EXPECT:
• Evaluation of your child's specific learning abilities in academics, learning styles, and
personal/social behaviors at the beginning of the program
• Creative teaching and learning opportunities for your child
• Assessment of progress made during the program and a final report which may be
shared with you
FOR MORE INFORMATION:
Please contact:
Pat Hensley, Director
Summer Learning Place
Education Department, Furman University
3300 Poinsett Highway
Greenville, SC 29613-1134
patricia.hensley@furman.edu
Information Form
Summer Learning Place 2014
Furman University
Name of Child:
Name of School:
Date of Birth: Disability, if any:
Grade Placement (2013-2014): Name of Teacher:
If applicable: Resource Self-contained Other Services:
Name of Parent/Guardian:
Home Address:
Telephone Number (work): (home/cell):
E-mail Address: Gender (of child): Male Female
Who will bring child to SLP?_________________________ Who will pick up child?____________________________
Is your child eligible for free or reduced lunch? Yes No
Payment information:
Visa Mastercard Check
Amount: $50 deposit $150 (paid in full) $100 balance due Other amount ___________
Card number: ________________________________________________________________________________
Three-digit security code (on back of card): _____________________ Exp. Date: _______________________________
Billing zip code: _______________________________________
Please Submit Form to: Erikah Haavie, Summer Learning Place,
Education Department, Furman University, Greenville, SC 29613-1134
erikah.haavie@furman.edu or FAX: 864-294-33412
Teacher Information Sheet: Assessment Results
Student name: _______________________________________________________________________________
Intelligence Other Psychological Assessments
Name of Test: Name of Test:
Date Administered: Date Administered:
Verbal IQ: Results:
Performance IQ:
Full Scale IQ:
Achievement Assessments:
Special Strength(s):
Areas of Need:
Teacher's Observations and Recommendations (use back of sheet for additional information):
Related Services Received:
(Please use additional sheets if needed)Medical Information Form
Summer Learning Place
Furman University
Child's Name: __________________________________________________________ Age: ___________________
Parent/Guardian Name(s): ___________________________________________________________________________
Daytime Phone: ______________________________ Cell phone #: _________________________________________
Emergency contact name/phone number: ______________________________________________________________
(if different from above)
Does your child have any dietary/food restrictions? ______Yes _______No
If yes, please describe: _______________________________________________________________________________
List any specific allergies: ____________________________________________________________________________
Is medication for allergy being given? ______Yes _______No
If yes, indicate name of medication: ___________________________________________________________________
If yes, are there any side effects? Please describe: _______________________________________________________
Is your child on any medication for behavior control? (hyperactivity, attention deficit, depression, etc.)?
______Yes _______No
If yes, please indicate name of medication: _____________________________________________________________
If yes, are there any side effects? Please describe: _______________________________________________________
Is your child on any medication for epilepsy or other convulsive disorder? _______ Yes _________ No
If yes, please indicate name of medication: ____________________________________________________________
If yes, are there any side effects? Please describe: ______________________________________________________
Please explain any other medical difficulties of which we should be aware: ________________________________
___________________________________________________________________________________________________
Parent/Guardian Signature: __________________________________________________________________________
Date: _______________________________
Please submit form to:
Erikah Haavie, Summer Learning Place, Furman University Education Department,
3300 Poinsett Highway, Greenville, SC 29613-1134, fax (864) 294-3341,
or e-mail to erikah.haavie@furman.edurev: 3/14
Furman University Acknowledgement and Release Form
My child’s school has my permission to send information concerning my child's educational progress
to Furman University.
School name: __________________________________________________________________
Parent Signature: ______________________________________________________________
I, the undersigned, acknowledge that my son/daughter is voluntarily participating in Summer Learning Place, which is
being offered by Furman University. This program will begin July 8 and end July 31, 2014.
ASSUMPTION OF RISK AND RELEASE OF CLAIMS. In consideration of being permitted to participate in the Activity,
I acknowledge that I am aware of the possible risks, dangers, and hazards associated with my participation in the
Activity, including the possible risk of severe or fatal injury to myself or others. In return for the University allowing me
to voluntarily participate in the Activity, I agree to assume and accept all risks arising out of, associated with, or related
to my participating in the Activity and to be solely responsible for any injury, loss, or damage which I might sustain
while participating in the Activity. These risks include, but are not limited to, travel to and from location(s) visited
during the Activity.
To the maximum extent permitted by the law, I release and indemnify Furman University and its officers, directors,
employees, volunteers, and representatives, from and against any present or future claim, loss, or liability for injury to
person or property which I may suffer, or for which I may be liable to any other person, during my participation in the
Activity. I also grant Furman, in its sole discretion, full permission to take and use photographs of me, either alone or
with others, in any way deemed desirable by Furman. I do understand that my child’s last name will not be used in
conjunction with any video or digital images.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AGREE TO BE
BOUND BY ITS TERMS.
Child’s Name Today’s Date
Parent Signature
Please mail to:
Erikah Haavie, Summer Learning Place, Furman University Education Department,
3300 Poinsett Highway, Greenville, SC 29613-1134, fax to (864) 294-3341
or e-mail to erikah.haavie@furman.eduYou can also read
