Request for Personal Curriculum for Students with an IEP

Request for Personal Curriculum for Students with an IEP
DIRECTIONSThis request is to be completed by parent(s), guardians(s), and/or an adult student. This form needs to be submitted to the Personal Curriculum Committee for consideration of a personal curriculum (PC Following the receipt of this request, if the student is eligible for a PC, the counselor or designee will schedule a meeting to continue with the PC Process. Please be sure that the student's career information/educational development plan (EDP) iscorrect in Naviance
Date of Request

MonthDayYear
Date
STUDENT INFORMATION

Complete all sections
Name of Student
Grade
Birth Date

MonthDayYear
Date
Anticipated Graduation Date

MonthDayYear
Date
School: Cedar Springs High School
Counselor
Name of Requestor
Daytime Phone
Format: (000) 000-0000.
Requested By

ParentGuardianStudent (18 or older)School Personnel
MODIFICATION REQUEST

Select what area(s) to Michigan Merit Curriculum are in need of proposed modification(s)
English Language Arts - 4 Credits

Grade 9Grade 10Grade 11Grade 12
Mathematics - 4 Credits

Algebra 1Algebra 2GeometryAdditional Math Related Credit
Science - 3 Credits

BiologyChemistry or PhysicsAdditional Science:
Social Studies – 3 Credits

World History/GeographyUS History/GeographyEconomicsGovernment
Physical Education & Health – 1 Credit

PEHealth
Modern Business I - .5 Credits

Modern Business I
Visual, Performing, or Applied Arts - 1 Credit

Visual, Performing, or Applied Arts
World Language - 2 Credits

World Language
World Language
ASSURANCE OF PERSON REQUESTING PERSONAL CURRICULUM

Check the box after reading the statement
The Michigan Merit Curriculum MMC requires that the student earn specific credits in order to graduate from high school. Credits are earned when the student demonstrates competencies in content expectations in the given subject areas. The law allows certain modifications of these credits and/or expectations through the development of a Personal Curriculum PC A Personal Curriculum Eligibility Committee will meet to determine eligibility.

I understand that modifications to the Michigan Merit Curriculum may limit the student’s readiness to be admitted to college, be eligible for college scholarships, enter trade school, secure a job in a career choice, or be eligible for NCAA athletic programs.I understand major modifications to the MMC may not result in a Michigan diploma.As an emancipated student, parent or legal guardian who has chosen to participate in a PC, it is my responsibility to maintain communication quarterly with teachers regarding the areas of modification.I understand that the student may or may not be eligible for further consideration of a PC, even though a PC is requested.I understand that if the student does not fulfill the approved Personal Curriculum, the PC is null and void; the student is obligated to make up the class(es) that were waived by the PC in order to be eligible to graduate.
SIGNATURES
Requested By
Signature
Date

MonthDayYear
Date
Should be Empty:

Request for Personal Curriculum for Students with an IEP

STUDENT INFORMATION

MODIFICATION REQUEST

ASSURANCE OF PERSON REQUESTING PERSONAL CURRICULUM

SIGNATURES