2021-2022 Credit Recovery Referral

CREDIT RECOVERY REFERRAL

2021-2022 Duluth Area Learning Center
PARENTS/GUARDIANS: Please be sure to fill in Section 1 completely, sign section 3, and continue on to the Continual Learning Plan section.
Technology Village: 11 E Superior St, Suite 140, 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.

Credit recovery is a digital curriculum with Teacher support

Classrooms will be open Monday-Thursday for Credit recovery students 3:45-5:00P
Section 1

Student/Family Info
Name

First Name Middle Initial Last Name
Student Date of Birth

Month Day Year
Date
Gender

Male Female
Grad Year (GSY)
Parent/Guardian Name
Full Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian Home/Cell number
Please enter a valid phone number.
Parent/Guardian email 1
example@example.com
Parent/Guardian email 2
example@example.com
Note: if applicant is an out of district student please provide a "referring district" student data sheet with MARSS Number.
Does student have a 504 plan?

Yes No
Does student receive Special Education Services?

Yes No
If student has a 504/IEP plan, please submit a copy to ALC by any of the following options:
- Email
  - valarie.wagenbach@isd709.org
  - kathleen.wilson@isd709.org
- Fax
  - 218.336.8770
- Stop into ALC
  - Monday-Thursday
  - 8:00am-5:00pm
Please select your student's counselor
Case Manager Email
example@example.com
Section 2

STAFF ONLY
Please select Class(es), Semester (A or B) and Credit amount (0.5 or 1.0)
English 9 A B 0.5 1.0
English 10 A B 0.5 1.0
English 11 (includes Am. Lit) A B 0.5 1.0
Values in Literature 0.5
Grammar & Composition 0.5
Civics in Global Society 0.5
United States History A B 0.5 1.0
World History A B 0.5 1.0
Economics 0.5
American Government 0.5
Intermediate Algebra I A B 0.5 1.0
Algebra II A B 0.5 1.0
Geometry A B 0.5 1.0
Probabilities and Stats A B 0.5 1.0
Physical Science A B 0.5 1.0
Biology A B 0.5 1.0
Physics A B 0.5 1.0
Chemistry A B 0.5 1.0
Work Experience Seminar 0.5
Work Experience Internship (Seminar prerequisite) 0.5 1.0
Health 0.5
Physical Education 0.5
Music 0.5
Art 0.5
Spanish 1 A B 0.5 1.0
School
Counselor/Admin. Signature

Clear
Date

Month Day Year
Date
Counselor/Admin. Signature is necessary for any student who has attended ISD709 classes within the past 12 months
Section 3

Signatures
I (student) 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
I (parent/guardian) 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
ALC 2021-2022 CONTINUAL LEARNING PLAN

PARENTS/GUARDIANS: Please be sure to completely fill in Section 1 AND sign Section 2 at the bottom of this CLP.
Section 1

Student/Family Info
STUDENT NAME
Full name
BIRTHDATE

Month Day Year
Date
GRADE
STUDENT PHONE NUMBER
Include area code
STUDENT PERSONAL EMAIL
example@example.com
PARENT NAME
Full name
ADDRESS
House #, street, apt (if applicable,) city, state, zip
Please check all that apply

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

Special Education (IEP) 504 Families in transition
Section 2

Signatures
PARENT SIGNATURE

Clear
STUDENT SIGNATURE

Clear
Section 3

STAFF ONLY
Educational Goals for the current school year
Courses student is enrolling in
STAFF SIGNATURE

Clear
Should be Empty:

CREDIT RECOVERY REFERRAL

Section 1

Section 2

Section 3

Section 1

Section 2

Section 3