9_26 Fillable Elko Online Form.pdf - Google Drive

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Page 1 of 3. ELKO COUNTY SCHOOL DISTRICT. Elko Online. Online Distance Education. Please print all information except si
ELKO COUNTY SCHOOL DISTRICT

Elko Online Online Distance Education Parent Information

Please print all information except signatures. Name: (Last, First)

Parent or Guardian Name:

Address: Work Phone: City: Student Phone Number:

Birth Date:

Grade Level:

Zoned High School:

Home Phone:

Parent Email Address:

Website: http://www.elko.k12.nv.us/pages/elko_online.html Reason: (Check one) Early Graduation

Medical Reason

Long Term Suspension

Alternative to Home School

Other Information: Does the student currently have an IEP? Yes No Is the student involved in extra-curricular activities or sports? Yes No

Please answer the following questions (type or print clearly): Enrollment in Elko Online classes is currently open to 7 th-12th grade students that are at risk of dropping out of school, are faced with circumstances that prevent them from attending regular class at their attendance area school, are trying to graduate early, or are looking for an alternative to home school. A meeting with a student’s Special Ed. Teacher must be conducted prior to the enrollment in any Elko Online courses if a student has an IEP.

1. Why do you want to enroll in on-line classes?

2. How will you and your parent(s) make the online program work for you? (Examples: daily study schedule, weekly progress checks by parents, setting goals for the timely completion of course work, etc...)

3. Completed the Test of Online Learning Success (Tools) at http://faculty.txwes.edu/mskerr/tools.html? Visit the website, and click on “Take Tools online”. When you are finished, click Tally and print your results. Attach your results to this application. I have completed the Test of Online Success. 4. If you are new to this program, you are required to take an orientation course to determine whether this program might work for you? You will have two days to complete the orientation course. The results from this orientation course will be used to determine if you will be allowed to enroll in Elko Online courses. Please indicate below if you have read and if you understand this requirement. I have read and I understand this requirement. 5. An orientation class for the student and a parent is mandatory prior to beginning classes. You must contact the school coordinator to schedule an appointment. I have read and I understand this requirement. 6. It is the responsibility of the student and parent to check the progress of each course. I have read and I understand this requirement. 7. Students will be required to participate in all state standardized testing at their attendance area school. I have read and I understand this requirement.

You must meet with your counselor and fill out a complete schedule for the year. It may be adjusted as need during the school year. What classes do they need to take first semester?

First or Second semester of the course

What classes do they need to take for second semester?

First or Second semester of the course

1. 2. 3. 4. 5. 6.

1. 2. 3. 4. 5. 6. Required Signatures – I have read the Elko Online information sheet and I understand and agree to all requirements for enrollment in Elko Online courses. Parent/Guardian _________________________________

Date ____________

Student ________________________________________

Date ____________

Counselor ______________________________________

Date ____________

Principal _______________________________________

Date_____________