Jefferson County Educational Service Center

KNOX COUNTY EDUCATIONAL SERVICE CENTER eCLASSES Revised 6/15/09 ____ Summer School 09 APPLICATION TO ENROLL ____ Full Year 2009-10 SCHOOL YEAR

District Representative: Please complete the eClass Application and then submit to the address below. KCESC is not responsible for ensuring that the classes chosen are those needed by the student for graduation.

Name of Student:______Email: ______

Name of Parent: ______Email: ______

Address: ______street city state zip

Phone 1: ______Phone 2: ______

School district: ______Student Grade: ______

Check here if student enrolling has a current IEP. Please enclose a copy of IEP with application.

ADDITIONAL CONTACT PERSON(S): Please list the name, email address(es) and phone numbers of any other person(s) besides the student who should receive direct communication from the instructor for this student. If parent, simply write “Parent” on the Name line.

______Name Email address (required)

______Point of contact phone number Point of contact fax number

Please circle party with fiscal responsibility: School district Parent Other: ______-

AUTHORIZING SIGNATURES

______Principal Signature Date

______Superintendent Signature Date

______Student Signature Date

______Parent Signature Date

Please fax to: (740) 393-6812 Knox County Educational Service Center ATTN: Bonny Buffington KCESC use only 308 Martinsburg Rd. ____ add user Mount Vernon, OH 43050 ____ add classes 740-393-6767 (phone) ____ copy to assignments ____ send to EMIS ____ send to teacher ____ send to admin KNOX COUNTY EDUCATIONAL SERVICE CENTER VIRTUAL CLASSROOM COURSE OFFERINGS Please place a check on the line next to the desired courses and write the last name of the district teacher who will be issuing credit for the course. Write KCESC on the Teacher line if you want KCESC to provide the instructor. Credit: COURSE EMIS CODE TEACHER Credits are based on mastery and/or 120 hours of student active 6th GRADE ___ Language Arts 6 050154 ______Teacher learning time per full year course, depending on the home ___ Reading 6 050104 ______Teacher school’s policy. Teachers may add additional requirements, ___ Math 6 110150 ______Teacher research papers, and/or essays to online content in order to ___ Social Studies 6 151210 ______Teacher assign final grade. All full year courses taken during the regular ___ Science 6 132120 ______Teacher 7th GRADE school year require mid-term and final exams to be taken at ___ Language Arts 7 050156 ______Teacher KCESC or home school as part of course requirement. All ½ ___ Reading 7 050106 ______Teacher credit courses and summer session courses require final exams ___ Math 7 110175 ______Teacher to be taken at KCESC or home school. ___ Social Studies 7 151201 ______Teacher ___ Science 7 132130 ______Teacher 8th GRADE TIME LINE: ___ Language Arts 8 050156 ______Teacher REGULAR SCHOOL YEAR: ___ Reading 8 050106 ______Teacher ___ Math 8 110175 ______Teacher First semester: Enrollment Aug. 1, 2009 – Sept. 30, 2009 ___ Social Studies 8 151201 ______Teacher Midterms – student to arrange date and time with home ___ Science 8 132130 ______Teacher school or with KCESC ___ Pre-algebra 110050 ______Teacher Midterms must be taken by Jan. 31, 2010 9-12 English/Language Arts ___ English I 050160 ______Teacher Second semester: Enrollment Dec. 1, 2009 – Jan. 31, 2010 ___ English II 050170 ______Teacher Final exams – student to arrange date and time with home school ___ English III 050180 ______Teacher or with KCESC ___ English IV 050190 ______Teacher Final exams must be taken by May 30, 2010 ___ Intervention English 050014 ______Teacher ___ Intervention Reading 050119 ______Teacher All coursework must be complete by June 1, 2010 in order to ___ Literature I 050300 ______Teacher receive credit for the 09-10 school year. ___ Literature II 050300 ______Teacher ___ Composition I 050400 ______Teacher SUMMER SESSION: 9-12 Social Studies ___ World History 150890 ______Teacher Enrollment May 1, 2010 – June 30, 2010 ___ US History 150810 ______Teacher Work must be completed and final exams taken by August 20, ___ Economics 150600 ______Teacher 2010 ___ Government 150300 ______Teacher Midterm and Final exams must be taken at the home school ___ Sociology 151300 ______Teacher ___ Psychology 151121 ______Teacher or at KCESC 9-12 Mathematics ___ Intervention Math 110190 ______Teacher INSTRUCTORS: ___ Real World Math 110190 ______Teacher Please write “KCESC” on the Teacher line if you would like ___ Pre-algebra 110190 ______Teacher ___ Algebra IA 110480 ______Teacher KCESC to provide the instructor. If nothing appears on the ___ Algebra IB 110301 ______Teacher Teacher line, we will assume that the district is providing the ___ Algebra I CP 110301 ______Teacher instructor. KCESC will provide district contact person with ___ Algebra II 110302 ______Teacher EMIS data for all teachers provided by KCESC and will provide ___ Geometry 111200 ______Teacher ___ Intro to Calculus 110600 ______Teacher training for district instructors who teach eclasses. ___ Trigonometry 111600 ______Teacher ___ Statistics 111500 ______Teacher PRICING: 9-12 Science Enrollment fee: $______Earth/Space Science 132240 ______Teacher ___ Life Science 132230 ______Teacher $225 regular school year; $150 summer session ___ Physical Science 132220 ______Teacher Number KCESC instructors:______x $175= +$______Biology 132330 ______Teacher ___ Chemistry 130301 ______Teacher ___ Advanced Chemistry 132326 ______Teacher ___ Physics 132325 ______Teacher Total due for this registration: $______9-12 Health ___ Health (1/2) 260101 ______Teacher REFUNDS: 9-12 Family and Consumer Science Fees for students who withdraw without completing will be ___ Career Awareness (1/2) 230000 ______Teacher ___ Personal Finance (1/2) 230300 ______Teacher refunded on a pro-rated basis based on number of days/180 9-12 Art students used the software. Fees for students who withdraw ___ Art Appreciation 020100 ______Teacher after March 20 for regular school year courses or July 31 for Foreign Language summer session will not be refunded. ___ Spanish I* 060265 ______Teacher

If you are interested in a course that does not appear here, please contact Bonny Buffington at KCESC at 740-393-6767. Technology classes may be added at a future date if there is sufficient interest.