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REACH Parent Statement

REACH Parent/Guardian Statement

Deadline: Friday, February 27, 2026

This information should be filled out by the applicant's parent or guardian.

If you have any questions, please contact Mr. Terry Lipford, via email or at 216-321-8260 x8394.

Applicant Last Name*

Applicant First Name*

Your Last Name*

Your First Name*

Your relation to applicant*

Your Email*

Parent/Guardian 1 Information

Last Name of Parent/Guardian 1*

First Name of Parent/Guardian 1*

Parent/Guardian 1 relation to applicant*

Home Address

Street*

City*

State*

Zip*

Phone(s)

Home*

Work*

Cell*

Email Address*

Employment

Occupation*

Employed by*

Parent/Guardian 2 Information

Last Name of Parent/Guardian 2

First Name of Parent/Guardian 2

Parent/Guardian 2 relation to applicant

Home Address

Street

City

State

Zip

Phone(s)

Home

Work

Cell

Email Address

Employment

Occupation

Employed by

Are Parents?*

With whom is the child living?*

What special activities is your child involved in that are particularly important to you and to him (e.g. piano lessons, gymnastics, church group, baseball, summer camps, youth club, etc.)? Please list in order of importance.

Special Activity 1.*

Special Activity 2.*

Special Activity 3.*

Special Activity 4.

Special Activity 5.

Special Activity 6.

Why would you like to see your child enrolled in the REACH Program?*

Is your son willing to try new and challenging activities under the guidance and supervision of adults?*

The REACH Program requires students to participate in all activities unless they are medically unable to do so. These activities might include hiking, swimming, and other strenuous recreational activities. Is your son willing to try new and challenging activities under the guidance and supervision of adults?

Yes

Is your son willing to try new and challenging activities under the guidance and supervision of adults? If no, please explain.*

REACH students are also expected to participate in follow-up activities during the regular school year.

Do you see any possible conflicts with follow-up activities?*

Yes

Do you see any possible conflicts with follow-up activities? If yes, please explain.

Has your son ever undergone an Evaluation administered by a clinical psychologist, school psychologist or educational specialist?*

*Evaluation

Yes

If yes, please briefly describe the results of the evaluation and any accommodations.

Should your child be accepted into the program and decide to enroll, you will need to plan family events around the dates of the REACH Program. Except in case of illness, attendance is mandatory.

Do you see any possible conflicts with the dates of the summer session for the 2026 REACH Program (Monday, June 15 - July 17, 2026)*

*Conflict with dates

Yes

Possible Conflicts, If yes, please explain.

The REACH Program is hosted during the summer at the University School Hunting Valley Campus. We provide shuttle bus transportation between the University School Shaker Heights Campus (20701 Brantley Road, Shaker Heights, Ohio 44122) and the University School Hunting Valley Campus (2785 SOM Center Road, Hunting Valley, Ohio 44022) each day in the morning (shuttle bus departs the Shaker Heights Campus at 8:00 am) and in the afternoon (shuttle bus returns to the Shaker Heights Campus at 4:00 pm). Students may choose to ride the shuttle bus or students may be dropped off directly at the University School Hunting Valley Campus.

Do you foresee any difficulties in providing transportation for your son to and from either University School’s Shaker Heights Campus or to and from University School’s Hunting Valley Campus?*

*Transportation

Yes

If yes, please explain.

The REACH Program is primarily funded through foundation grants and University School. However, please note that there is a $100.00 Activity Fee for all students. This Activity Fee is due only upon acceptance into the program.

I understand that signing my name and clicking "Submit" certifies that I have completed the Parent/Guardian Statement. If my son is accepted to the REACH Program, my family and I will not plan special events during the dates and times of the summer sessions.

Parent/Guardian Signature*

Date*