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 placed in the teacher’s
P-day box at the classroom, during school hours, 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