Independent Study Program Temecula Preparatory School Student Name:
Address:
Date:
City: State:
Phone#:
Date of Birth:
Age:
Total duration (Number of school days) absent:
Date: (Last day of school)
Date: (First day on ISP)
Date: (Last day on ISP)
Date: (First day of return)
Purpose for Independent Study request:
Zip Code:
Grade:
Objective: The major purpose of the duration of this agreement is to enable the student to keep current with his/her grade studies for the period covered by this agreement. • This agreement is to enable the students to successfully reach the objectives and complete the assignments identified in the Assignment and Work. • Record Form(s) that will be a part of this agreement. With the support of the parent, guardian or caregiver the student will submit assignments on or before their due date. • All Independent Study contracts must be signed by student, parent, teacher(s) and staff PRIOR to the start of the absence. • All work in the contract as listed on the Assignment (page 2 of 3) must be completed for credit. Agreement: We have read and understand the terms of this agreement, and hereby agree to all the provisions. Student Signature:______________________________________________________
Student: I understand that: • Independent Study is a form of education that I have chosen during my absence at TPS. • I will maintain proper care or all books and materials provided to me for my assignment and return in same condition at the time of my return to school. • If I do not complete the assignments as listed on this agreement, my incomplete work will result in review of my agreement and I may not be allowed to continue in Independent Study. • Independent Study allows me to stay current with my classmates in the assignments given in class. Student signature: ____________________________________________________
Parent: I understand that the major objective of Independent Study is prove a voluntary educational alternative for my son or daughter during their absence at TPS. I agree to the above conditions listed under “student”. I also understand that: • Learning objectives are consistent with and evaluated in the same manner that they would if my son or daughter were at school. • If my child has an Individualized Education Program (IEP), the IEP must specifically provide for his or her enrollment in Independent Study. • I am responsible for supervising my child while he or she is completing the assigned work and for ensuring the submission of all completed assignments necessary for evaluation. • I am liable for the cost or replacement or repair for willfully damaged or destroyed books and other school property checked out to my son or daughter. • I have the right to appeal to the school administrator any decision about my son’s or daughter’s placement or school program in accordance with the Temecula Preparatory School’s procedures.
I understand that any trip, excursion or other activity undertaken under Independent study is not school sponsored and I assume all responsibility, costs and expenses for any such trip, excursion or activity during the term of this independent study agreement. I understand that the School does not assume any responsibility for any such trip, excursion or other activity undertaken during this independent study agreement nor does the school warrant the quality of any such trip, excursion or other activity.
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