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Elective Verification Form
Please fill a form out for each elective credit you are wanting verified for credit.
Today's Date
-
Month
-
Day
Year
Date
Student Name
First Name
Last Name
Student or Parent Email
example@example.com
Teacher Name (who actually taught the course/lesson/class)
First Name
Last Name
Name of Course
Final Grade
A
B
C
D
F
Course Start Date
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Month
-
Day
Year
Date
Course End Date
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Month
-
Day
Year
Date
Course Scope and Sequence Summary: Scope, Sequence, Content Outline, Curriculum Provider, etc.
Total numbers of hours student spent on class: (For high school: 75 hours = .5 credit, 150 hours = 1 full credit)
Completion artifact: Please submit two student samples from the course. Examples may include: Short research paper related to content, student summary of participation and what was learned, final assessment results, projects completed, assignment examples, and or pictures demonstrating completion of the course.
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Parent or Teacher Signature:
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Should be Empty: