2021-2022 AREA LEARNING CENTER (ALC) SUMMER SCHOOL REFERRAL

2021-2022 AREA LEARNING CENTER (ALC) SUMMER SCHOOL REFERRAL

June 14, 2021 through July 1, 2021, Mondays, Tuesdays, Wednesdays, Thursdays 8 AM - 4 PM. Historic Old Central High School (3rd Street Entrance), 215 N. 1st Ave. E., Duluth, MN 55802 Phone: (218) 336-8756 Fax: (218) 336-8770
This program is open to youth ages 16 to 20 who meet one or more of the state eligibility guidelines. If you are currently enrolled and have not completed your Credit Recovery course(s) with ALC, you MUST enroll again for the summer school program with ALC using this form. You will continue where you left off in the course with Credit Recovery (you do not start over
Student Name: Last
First
Middle
Grad Year (GSY)
Student Date of Birth
Male/Female (Choose One)
Parent/Guardian Name
Street Address
City
State
Zip code
Home Phone
Cell Phone
Parent Email
example@example.com
Parent Email 2
example@example.com
Student Personal Email
example@example.com
Federal Ethnicity Codes: please choose number
State Ethnicity Codes: please choose number
Choose a Counselor
Note: If applicant is an out of district student, please attach a "referring district" student data sheet with MARSS Number, as well as the Duluth Public Schools Registration Form signed by a parent/guardian or the adult student.
Student has a 504 Plan

Yes No
Student receives Special Education Services

Yes No
Please attach supplemental Information about required 504 Plan or IEP learning adaptations and/or modifications.
COUNSELOR: Choose class, semester and credit
English 9 I II 0.5 1.0
English 10 I II 0.5 1.0
English 11 (includes Am. Lit.) I II 0.5 1.0
Values in Literature 0.5
Grammar & Composition 0.5
Civics in Global Society 0.5
United States History I II 0.5 1.0
World History I II 0.5 1.0
Economics 0.5
American Government 0.5
Intermediate Algebra I I II 0.5 1.0
Algebra II I II 0.5 1.0
Geometry I II 0.5 1.0
Probabilities and Stats I II 0.5
Physical Science I II 0.5 1.0
Biology I II 0.5 1.0
Physics I II 0.5 1.0
Chemistry I II 0.5 1.0
Work Experience Seminar 0.5
Work Experience Internship (Seminar is a prerequisite) 0.5 1.0
Health 0.5
Physical Education 0.5
Art 0.5 1.0
Music 0.5 1.0
Spanish I I II 0.5 1.0
Counselor/Admin. Signature: Necessary for any student who has attended ISD709 classes within the past 12 months
Counselor/Admin. Signature

Clear
Date

Month Day Year
Date
School
Student Signature/Agreement I understand the ALC program requirements. I will work cooperatively with my counselor to develop a Continual Learning Plan (CLP) and promise to put forth full effort to achieve my stated goals.
Student Signature/Agreement

Clear
Date

Month Day Year
Date
Parent or Guardian/Agreement I understand the ALC program requirements. I support the decision of my son/daughter to enroll in the program and expect him/her to work cooperatively with his/her counselor to develop a Continual Learning Plan (CLP) and to put forth full effort to achieve the stated goals.
Parent or Guardian/Agreement

Clear
Date

Month Day Year
Date
2021-2022 ALC SUMMER SCHOOL REFERRAL - CONTINUAL LEARNING PLAN
STUDENT'S NAME
BIRTHDATE

Month Day Year
Date
GRADE
PARENT'S NAME (PRINTED)
ADDRESS
STUDENT PHONE
PARENT/GUARDIAN PHONE
Indicators of Need: (Check all that apply)

Performs substantially below the performance level for pupils of the same age in locally determined achievement test Is a victim of physical or sexual abuse. Has experienced mental health problems. Is at least one year behind in satisfactorily completing coursework or obtaining credits for graduation Has experienced Homelessness sometime within six months before requesting a transfer to an eligible program. Is pregnant or Is a parent. Speaks English as a second language or has limited English proficiency LEP Has been assessed as chemically dependent. Has been excluded or expelled according to sections 121A.40 to 121A.56. Has withdrawn from school or has been chronically truant Has been referred by a school district for enrollment in an eligible program or program pursuant to section 124D.69. Student has met one or more of these criteria.
Current Services

Special Education (IEP) 504 Families in transition
Please attach supplemental information about required 504 Plan or IEP learning adaptations and/or modifications.
Goal for current school year
STAFF SIGNATURE

Clear
STUDENT'S SIGNATURE

Clear
PARENT'S SIGNATURE

Clear
Should be Empty:

2021-2022 AREA LEARNING CENTER (ALC) SUMMER SCHOOL REFERRAL

2021-2022 ALC SUMMER SCHOOL REFERRAL - CONTINUAL LEARNING PLAN