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Santa Maria-Bonita SD |  E  6158  Instruction

Independent Study Agreement   

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This agreement is entered into under the authority of Education Code 51747 and BP/AR 6158 and complies with Ed. Code 46300.7 and 51747.3. No student shall be required to participate in Independent Study

Student Student I.D. # Birthdate

Address Telephone (Home) (Work)

Parent/Guardian/Caregiver

Teacher Grade School Track

The reason for participation by student in a voluntary Independent Study Plan (ISP) is: (circle one)

Travel Emergency Visiting Relatives Other (Explain below)

Student and his/her parent(s)/guardian(s)/caregiver(s) understand that once student has been in the independent study program and out of his/her regular classroom assignment for 10 school days, that return to the original classroom is dependent upon space availability.

Program of Instruction

1. Set forth the time, place, manner and frequency for submitting student's assignments and for reporting student's progress: Student must submit completed assignments upon return to regular classroom.

2. Set forth the objectives of the independent study program: Student will satisfactorily complete assignments, work and projects of his/her grade to aid in a smooth re-entry into school upon completion of ISP.

3. Set forth the activities selected by instructor for student to reach objectives: Student will receive assignments from teacher.

4. Set forth the methods utilized to evaluate the student's work: Student will submit assignments to the office upon return. Teacher will evaluate and award grades.

5. List the material resources which will be made available to student: Student will use same books and materials as regular classroom students.

6. List the staff who will be made available to student: Regular teacher and ISP staff.

7. Assignments given to student must be completed by: .

(BP 6158 provides for a maximum of one week for grades K-3 and two weeks for grades 4-8)

8. This agreement will begin on and terminate on

for a total of days.

9. Student will receive an appropriate letter grade for completion of work under this program.

If you are a student who has been assigned to independent study pursuant to an expulsion proceeding under Section 48915 or 48917 of the California Education Code, instruction may be provided to you through independent study only if you have been offered the alternative of classroom instruction.

I have been offered, as an alternative to independent study, the option of assignment to a classroom setting. Please initial here .

Agreement of Participants

I understand that the independent study program set forth above is designed to assist me in meeting the core curriculum requirements of this school district. I am committed to meeting the requirements of this program.

DATED:

Signature of Student

I/we, the parent(s)/guardian(s)/caregiver(s) of the above named student, consent to the student's participation in independent study program set forth above.

DATED:

Signature of Parent/Guardian/Caregiver

DATED:

Signature of Parent/Guardian/Caregiver

NOTICE

This agreement may not be put into effect until it is agreed to by the student and his/her parent(s)/guardian(s)/caregiver(s) and signed by all instructors who have direct responsibility for providing assistance to the student.

Signature of other teachers/aides Date Signature of other teachers/aides Date

Signature of other teachers/aides Date Signature of other teachers/aides Date

This Agreement is Approved by the Principal or Assistant Principal:

DATED:

Signature of Principal/Assistant Principal

FOR INDEPENDENT STUDY USE

DATE PLAN SATISFACTORILY COMPLETED: OTAL DAYS GRANTED::

TOTAL DAYS GRANTED EACH ATTENDANCE PERIOD:

FOR ADA INDEPENDENT STUDY AGREEMENTS MUST BE FOR 5 CONSECUTIVE SCHOOL DAYS OR MORE AND CANNOT BE CLAIMED FOR STUDENTS WHO ARE ENROLLED IN THE DISTRICT UNDER EDUCATION CODE 48204(f) i.e., (PARENT/GUARDIAN EMPLOYED IN DISTRICT).

Exhibit SANTA MARIA-BONITA SCHOOL DISTRICT

version: October 6, 1999 Santa Maria, California