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Please complete the fields below and sign
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* Student First Name:
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* Student Last Name:
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* Address:
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* City:
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* State:
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* Zip Code:
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* Student's Date of Birth:
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* First Phone Number:
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Second Phone Number:
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It is understood that:
Objectives: The student will complete the courses listed below. All course objectives will be consistent with the established school's
governing board policy and are consistent with school standards as outlined in the school's subject/course
descriptions. Assignment and Work Record (AWR) Forms will include additional descriptions of the major objectives and activities of the
courses of study covered by this agreement including the evaluation of student work and are incorporated herein. The term “Course
Value” (CV) refers to the number of credits (secondary education) or weeks of work (elementary education) the student will attempt.
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Please select your Program Placement
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Program:
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Please select the course category you will be taking
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* Course 1
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Course 2
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Course 3
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Course 4
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Please select the location you will be enrolled in
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* Location:
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(Location must be selected to choose Grade Level Next School Year)
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* Grade Level Next School Year:
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Year
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Methods of Study: Specific methods of study will be designated on the Student Assignment and Work Record (AWR) and Attendance Record
incorporated herein. Examples of methods of study for the student will include, but are not limited to: Independent Reading, Textbook Activities,
Problem Solving, Study Projects, Drill and Practice, Experiential Learning, Computerized Curriculum, Web/Internet Research, Library Research,
Field Trips, Learning Center Courses.
Specific Resources: The school will provide appropriate instructional materials and personnel necessary to the achievement of the
objectives and must include resources that are normally available to all students on the same terms as the terms on which they are
available to all. Resources include providing access to all pupils to connectivity and devices adequate to participate in the educational
program and to complete assigned work. Assignments and specific resources will be designated on the Assignment and Work Record (AWR) and
Attendance Record incorporated herein.
Additional Supports for Special Populations: Academic and other supports will be provided to address the needs of pupils who are not
performing at grade level, or need support in other areas, such as English Learners, individuals with exceptional needs in order to be consistent
with the pupil's individualized education program or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 (29 U.S.C. Sec. 794),
pupils in foster care or experiencing homelessness, and pupils requiring mental health supports. Additional supports include but are not limited
to free tutoring during regular school hours, intervention courses, specialized academic instruction, social emotional learning programs, and
additional supports as needed.
Methods of Evaluation: Academic evaluations will be designated on the Assignment and Work Record (AWR) and Attendance Record incorporated
herein. Other acceptable methods of evaluation include, but are not limited to: Teacher Made Tests, Student conferences, Progress/Report Cards, Chapter/Unit
Tests, Work Samples, and Observations, Portfolios, State Standards Testing, Learning Journals, Presentations, Quizzes, Labs, Finals.
Students are required to report to their teacher and receive reports on their academic progress as scheduled: Manner of Reporting may include
any or all of the following: One-on-One, Small Group, Email, Fax, Online. Time: During School Hours, Days: Monday – Friday. Frequency: Daily.
Duration: Full Year
Parents/Guardians are to receive communications regarding their student's academic progress as follows: Manner of reporting may include any or
all of the following: in person, via telephone, email, or in writing. Time: During School Hours. Frequency: Weekly.
Voluntary Statement: It is understood that independent study is an optional educational alternative in which no pupil may be required
to participate. In the case of a pupil who is referred or assigned to any school, class, or program pursuant to Education Code Section 48915
or 48917, instruction may be provided for a student through independent study only if the student is offered the alternative of classroom instruction.
Board Policies: According to the Charter School policy for grades through , the maximum length of time allowed between when the
assignment was made and the date by which the student must complete the assigned work shall be twenty (20) school days, unless an exception is made in accordance with the board
policy. The student shall make satisfactory educational progress, as defined in the Personalized Learning Policy. After a student has missed three (3) assignments during any period of twenty (20)
school days, and is determined to be making unsatisfactory educational progress, an evaluation will be made to determine whether it is in the best interests of the student to remain in independent study.
Additional courses may be added to this agreement as needed if the agreement is re-signed and re-dated by the teacher and the student.
Signatures and Dates: I have read and I understand the terms of this agreement, and agree to all provisions set forth.
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Please fill out the highlighted fields above!
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