Credit Flexibility Proposal

Date:  	

Student Name:

ID #

Grade:

Parent/Guardian Name and contact information:  	

Reason(s) for pursuing this program: Check all that apply.

Early graduation Credit/Course Advancement Transfer from another school

Parenting responsibility Home instruction Health/Medical

Other (Specify below)

Plan is for (Check one).  Each category requires a completed proposal or request.  All forms can be found on the district website.

 	  Create a Flex plan for an existing Sylvania Schools course (Credit Flexibility Proposal)

 	  Create Flex plan for a new course (Credit Flexibility Proposal)

 	  Test-out of a course (Test-out Request)

 	 Pursue a Sylvania Board approved Educational Option (Educational Options Plan)

Course Information:

Course Title:  	

Core Subject Area field(s) (e.g. Physical Science, Fine Arts, Social Studies, etc.):   	

Course duration:	 	All Year	 	Semester 1 only	 	Semester 2 only

Amount of Course credit:   	

School Year:   	

If an off-site instruction provider is involved, list the location and name of organization.

Student Contract:

Student explanation of goals and statement of commitment:

I, (student signature)	, understand the Independent Study/Credit Flexibility Option is an intensive process designed to allow me to work at my own pace to complete the assigned work.

The student and parent must initial each item below as indication of having read and accept the following:

Parent   Student

The student will hold primary responsibility for the overall success or failure of the course.

The student will be expected to allocate an average of week working toward the completion of this course.

hours per

The student will be expected to meet with the teacher of record at least time(s).

The student understands that all credit flex classes must be added and dropped according to board policy.

The teacher reserves the right to remove the student from the course (withdrawn with penalty) for issues involving plagiarism, copyright violation, multiple submission, or other forms of academic dishonesty.

The teacher’s decision regarding a withdrawal from the course with penalty may be appealed to the principal according to board policy.

Plan for Assessment to Receive Credit and Grades
(i.e. research paper, exam on specific date, and/or description of project)

Attach additional sheets if necessary.

State / National
Standards to be Evaluated	Demonstration Plan	Due Date

Consequences for failure to complete plan or to meet due dates

Detailed Description of Assessments and Timelines
(Add additional sheets if necessary)	
Due Date	

Signature of Student	Date

Signature of Parent	Date

Signature of Instruction Partner (if used)	Date

Signature of Teacher of Record	Date

Signature of Building Administrator	Date

Credit Flex Committee:

Date  	

 Approved	 Not approved   (Reason  	) Teacher of Record