Master Agreement for Independent Study

Cox Academy

Name: Grade: Teacher: Address: Age: Date of Birth: City: ZIP Code: Phone: School Name: IS Dates: Return Date:

 The major objective for the duration of this agreement is to enable the student to keep current with the EFC curriculum for the ______grade for the period covered by this agreement.  This agreement is to enable the student to successfully complete the assignments identified in the individual Learning Contract(s) and Assignment Sheet which will become a part of this agreement. With the support of the parent, guardian, or caregiver the student will submit assignments on or before the first day of school after the Independent Study contract ends.  According to EFC policy for Independent study in grade ______, the assigned work must be turned in no more than 10 school days after the date the student returns from Independent Study, unless the exception is made in accordance with EFC policy.  EFC will provide the teacher services, instructional materials and other necessary items and resources as specified for each assignment.  The student will complete the studies listed on the attached Learning Contract during the semester or term of this agreement as outlined in the EFC curriculum.  The student will turn his/her work in to the Office Manager on or before the first day of school after the Independent Study contract ends. The teacher will then evaluate the time value (apportionment credit) of the student’s work products.  Other:

Student I understand that:  Independent Study is a choice I have made and is not required of me and I can return to classroom instruction mode at any time.  I’m entitled to textbook supplies, supervision of a certified teacher, and all services and resources received by other children in my grade at my school.  If I do not return on the return date specified, I could be dropped from my classroom assignment.

I agree to:  Complete my assigned work as explained by my teacher or teachers and described in my written assignments on or before the first day of school after my Independent Study contract ends.

Parent/Guardian/Caregiver I understand that the major objective of Independent Study is to provide a voluntary educational experience for my child. I agree to the conditions listed under “student”. I also understand that:  Learning objectives are consistent with and evaluated in the same manner that they would be in a traditional program.  Unless otherwise indicated, my child will meet with the supervising teacher who signs this agreement. It is my responsibility to promptly reschedule my appointment missed due to an emergency.  I am responsible for supervising my child while completing school work and to ensure the completion of all assignments by the due date.  I am liable for the cost of replacement or repair of textbooks or other materials damaged or lost while checked-out to my child.  It is my responsibility to provide transportation to and from all educational activities specified in this agreement.

Student: Date: Resource: Date: Parent: Date: Administrator: Date:

Teacher: Date: Other Signature: Date: Cox Academy

Learning Contract

Teacher: ______Grade: ______

Students Name: ______Contract Period from: ______to: ______

Minimum hours of instruction /activity required: ______

Objectives (short term): Evaluation:

Subject: Course Materials Date Returned Completed Teacher to Teacher Y/N Initials

SUPERVISING TEACHER’S EVALUATION/CERTIFICATION STATEMENT To be completed by Supervising Teacher after evaluation of assignment

My signature below indicates that I, the assigned supervising teacher have personally evaluated the time value (apportionment credit) of the students work products, or that I have personally reviewed the evaluations made by other certified teachers.

Actual Days of Absence From______to______Date Assignments Evaluated______

Total Number Of Attendance Days Possible Total Number of Days Credited Total Number of Days Not Credited

Supervising Teacher’s Signature: ______Date: ______