Student
Name ___________________________ Grade ____
Age_____ Birth Date_______
Phone _________________________ Entry Date: Exit Date:
Objective:
The student will complete assignments for selected courses from the list
below as they are assigned by his/her Chrysalis Teacher. This agreement is to
enable the student to successfully reach the objectives and complete the
assignments identified in the Temporary Home Study Assignment Form that will be
a part of this agreement. The
completed assignments and the Assignment Form will be given
to the teacher on the first day the student
returns to school.
Methods of study will be hands-on activities and projects, textbooks, field trips, manipulatives, videos, and others listed on the Assignment Form that are developmentally appropriate to student’s understanding. The student will be provided with a teacher, textbooks, library books, manipulatives, videos, computer programs and other resources appropriate for successful completion of the assignments. All certificated Chrysalis staff is available for appointments to help a student.
This student will have Independent Study ______ days.
Subjects: Circle those included in agreement. Science Math Language Arts Social Studies P.E
Assignments: Assignments must be completed unless changes are arranged with the teacher.
Voluntary Statement: Participating in the Chrysalis School Program which may include some independent study is a continuously voluntary educational alternative. In the case of a pupil who is referred or assigned pursuant to Education Code 48915 or 48917, an alternative classroom has been offered and is available at all times.
Reporting Time: We, the parent and teacher, agree to meet in person or by phone. The student will meet as requested.
Frequency:
As Needed
Time: After
Agreement: We have read the terms of this agreement and agree to all the conditions set forth.
Student:_______________________________________ Date: ________________
Parent/Guardian:_______________________________ Date: ________________
Supervising Teacher: _____________________________Date:________________
Certification is on Assignment Form