PASS Application Form
(Parental Access Support System)
Sodus Central School District
www.soduscsd.org
PARENT/GUARDIAN (
please print
)___________________________________________
Home Address: ____________________________________________________________
Home Phone: _______________________ Work Phone: ___________________________
Email Address: ____________________________________________________________
I hereby give Sodus CSD permission to place information regarding the following students
in the PASS (
PARENTAL ACCESS SUPPORT SYSTEM
) program. A student ID number and
PIN will be assigned by the School District after this form is returned.
Student Name:___________________________
ID # ___________
PIN # ____________
(
please print
)
(provided by Sodus CSD)
Student Name:___________________________
ID # ___________
PIN # ____________
(
please print
)
(provided by Sodus CSD)
Student Name:___________________________
ID # ___________
PIN # ____________
(
please print
)
(provided by Sodus CSD)
Student Name:___________________________
ID # ___________
PIN # ____________
(
please print
)
(provided by Sodus CSD)
Parent or Guardian’s Signature:__________________________________
Date:______________________________
To ensure privacy of data, applications must be handed in to your student’s school building main
office with a form of identification, driver’s license preferred. A copy of this application will be
mailed to the Parent/Guardian listing each student’s ID # and PIN #.