AFTER SCHOOL

PROGRAM
. Hugo Elementary School
is partnering with

Hartsell Psycho 'ogical Services

and will be offering many more activities and support to ensure your child's success.
4

Read the attached letter and SIGN UP TODAY in the library with an In-Take Specialist or return the School Referral Form ASAP

1100 David Roebuck Lane

Hugo, Oklahoma 74743 (580) 326-8373 Fax: (580) 326-6312 Nancy Welch, Principal nwelch@hugoschools.com

August 10, 2011 Dear Parents, Hugo Elementary School has had the opportunity to combine funds through a 2pt Century After-School Grant and Hartsell Psychological Services to offer to your child after-school tutorials for the 2011-2012 school year. This free program is available for all students in 1st_8th grade within the Hugo School District on a first-come basis. The program is known as S':EPS j:() EMPOWER STUDENT SUCCESS and will include help on homework; explicit instruction in academic areas where your child needs help: extra curricula activities such as art and music; and whole group instruction on getting along with others; and learning to be responsible and respectful. Hartsell Psychological Services will provide counseling services to improve your child's overall well-being and coping skills to better equip them for the educational and life challenges they may face in the future. To be considered for participation in the after school program, you will need to complete the attached form and return it to school. Remember, space is limited and students will be accepted on a first-come basis. Thank you for allowing us to teach your child during the regul~r school day and we look forward to continuing to work with him/her in the after-school program.

Nancy Welch

STEPS TO EMPOWER STUDENT SUCCESS

Seeing your child succeed through the impact of positive reinforcement

SCHOOL REFERRAL FORM (GRADES 1-8) Client Name: -----------------------Address: DOB: Date:
--------

DM D F

_ SSN: _
_

Age: _

Parent/Guardian Name Relationship to Minor: Place of Employment:

(if client is a minor):

._ _ _

Home Phone: Work Phone:

------

Reason for Referral: STEPS Afterschool Program School

(if client is a minor): _

Teacher:

------------

Primary Care Physician: Soonercare/Medicaid/primary insuranceg.. TO PARTICIPATE

PERMISSION

I, , give my permission for my child, , to attend the STEPS Afterschool program sponsored by Hartsell Psychological Services. I also give permission for Hugo ISD and Hartsell Psychological Services to exchange information regarding my child for the purposes of participation in this afterschool progranl.

ClientlParent/Guardian Signature Hartsell Staff Signature

Date Date

*You will be contacted to complete enrollment forms for this program. All enrollment forms must be completed prior to student participation.