21st Century Learning Centers Grant

2016-17 After-School 21st CCLC Instructional Support/Enrichment Registration         Bedford Middle School                                                                                     April 17-21, 2017                 3:45-5:30pm

Student Name:  __________________________________________   Grade:   _____

Homeroom Teacher:  ______________  Parent Signature ______________________

Contact Phone # __________________________________________________

Emergency _Contact Name:  ________________________________ Emergency Phone #:  __________________

Medical Information (include food allergies): ______________________________________________________

Parent’s e-mail: ______________________________________________________________________________

This program is a student commitment to attend each registered class.            

Parents:   The instructional support/enrichment program is provided free and sponsored by the 21st Century grant.  The program is offered from 3:45-5:30pm, Monday through Friday.  Participating students will stay at school after normal afternoon dismissal, reporting to the cafeteria at 3:45.  A snack will be given to each after school participant, at 4:00 they will report to their designated afternoon support area.  


 This is extra help/review for the upcoming SOL’s beginning April 24.


Student’s choices:     After School SOL prep time – circle ALL your choices, mark your grade level/class name (ex. Algebra 1, concepts, Civics, etc)                                                 Grade                             Math/History/Science class

Monday:          READING     or     SCIENCE_______________________________

Tuesday:          READING     or     SCIENCE_______________________________

Wednesday:    MATH     or     HISTORY____________________________________

Thursday:        MATH     or     HISTORY________________________________

Friday:             SCIENCE     or     HISTORY______________________________

*Following are the only stops approved for the 21st Century bus.  You must choose from this list:

 (Montvale/Thaxton Bus Route)                                       (Big Island Bus Route)

Vista Foods                              Raintree                                              Longwood Minute Mart

Montvale Elementary             State Shop-DOT                                   Liberty High School

Thaxton Market                                                                                  Big Island Elementary School                        

(Exceptions are possible if student lives directly on routes-check with Mrs. Slingerland)

The following information is needed from all students. Please note that the 21st Century bus will not wait for parents/guardians at the stops and may take your child back to school if no one is there to get them.


____My child will ride the bus at 5:30pm and should be dropped off at (circle drop off location listed above)

____My child will be walking home after the instructional support session. (5:30pm)

____My child will be a car rider and picked up after the instructional support session (5:30pm)



All students are dismissed from BMS at 5:30pm

Registration forms are due as soon as possible or by Thursday, April 6. Forms can be sent back with students, emailed or Faxed, 586-4957.  If you have questions or concerns, please contact Mrs. Slingerland at BMS (586-7735) or sslingerland@bedford.k12.va.us    


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