Embed Size (px)
Citation preview
Interested in finding out more? Contact | e | [email protected] t | 403-817-7516 Are you interested in this program? Sign up to receive updates on the upcoming information session. Submission Deadline: Friday, December 3, 2021 @ 4:00 pm
Veterinary Practice: The Team Connection Online through Olds College (AHT1140)
This program is delivered fully online. There are no expectations of proof of vaccine in order to take part. Program Description Students will become familiar with the aspects of the service cycle within a veterinary clinic. Students will explore veterinary software and their specific application to operating a veterinary practice. They will apply communication skills to create positive experiences for veterinary clients. Upon successful completion: Students will receive 5, 3000 level CTS credits and 3 post-secondary credits. See example of course outline Olds College Dual Credit Student Tip Sheet | information about being an Olds Dual Credit student. Career Pathways
Veterinary Medicine Animal Health Technician
Animal Sciences Veterinary Technical Assistant
Certificate Student Eligibility Open to CBE high school students who:
o are in grades 11 or 12 as of September 2021 o have a strong interest to explore a pathway in animal sciences o are excited about taking a post-secondary course through an online format
The course is asynchronous, so students will not need to adjust their timetable. However, this is a rigorous post-secondary course and is the equivalent of one, 5 credit semester course.
Students must submit a personal learning schedule with their application (see application checklist for details).
Students should be on track or have successfully passed the following courses or equivalents:
o English Language Arts 10-1 or English Language Arts 10-2 o Science 10
Important Dates
Student applications must be received by your high school Off-campus Coordinator or Guidance Counsellor by Tuesday, November 30, 2021 for review and signature
Off-campus Coordinator or Guidance Counsellor will submit the application to [email protected] by Friday, December 3, 2021 no later than 4:00 pm
Courses will begin February 2022 through to June 2022 Program Benefits
Earn 5 CTS credits at the 3000 level Get a jump start on your post-secondary education while still at high school Build confidence through developing learning strategies and skills that support your
learning transitions Learn about on-going opportunities and experience post-secondary learning Taught by experienced instructors who are connected to industry and support students in
making meaningful connections to career pathways
pg. 1 Dual Credit and Exploratory Program Application Form Revision Date: October 2021
Dual Credit and Exploratory Program Application Form
Dual Credit /Exploratory Program Name: ____________________________________________
IMPORTANT - Off-campus Update
Effective January 1, 2022, all students participating in a Dual Credit or Exploratory program in-person at a partner location will require proof of full vaccination status (2 doses of a WHO approved vaccine). Proof of a
negative COVID-19 test will no longer be sufficient to attend in-person programs at partner locations. Students unwilling/unable to provide such proof will be unenrolled from their Dual Credit or Exploratory program and will need to arrange alternate learning with their home school. Please note this does not apply to online programs
that do not have any in-person components (field trips, labs, etc. are in-person).
Students must be 19 years of age or younger on September 1, 2021;
Students must be enrolled in a CBE high school for the duration of the program;
At this time International students are not eligible to participate in Dual Credit or Exploratory Programs;
Prior to applying please see program flat sheet for pre-requisites essential to be considered for the program;
Please complete the form digitally and print for handwritten signatures;
Applications should be sent in by the school Off-campus Coordinator or Guidance Counsellor on behalf of the
student;
All correspondence regarding this program, including a confirmation email upon receipt of the application, will bevia the CBE Student EDU email. Students must check their CBE email account.
A. STUDENT INFORMATION (fill in this section digitally)
Student Last Name____________________________ Student First Name____________________________________
Student AKA Name____________________________ Grade (as of September 1, 2021) ________________________
CBE Student ID # ___________________ ASN ______________________ DOB (MM/DD/YYYY)_________________
CBE Student EDU Email _______________________________________________________ (eg. [email protected])
Student Address_________________________________________________________________________________
Home Phone Number __________________________ Student Cell __________ ______________________________
Parent/Guardian Name _________________________ Parent/Guardian Email ________________________________
B. SCHOOL INFORMATION (fill in this section digitally)
Current School __________________________________________________________________________________
Off-campus Coordinator ______________________________ Phone Ext _____________ *Primary Contact
Guidance Counsellor_________________________________ Phone Ext _____________ *Primary Contact
*Please indicate the primary contact by checking the box beside one name. This person will be the school-based contactfor the student throughout the application process and the program.
pg. 2 Dual Credit and Exploratory Program Application Form Revision Date: October 2021
C. APPLICATION VERIFICATION Requirements:
1. Scheduling/ Personal Learning Schedule:
For face-to-face Dual Credit and Exploratory programs:
Have you verified with your Guidance Counsellor or Off-campus Coordinator that your high school schedule can be adjusted to accommodate this program?
Yes _______ Guidance Counsellor/Off-campus Coordinator initials OR
For online asynchronous Dual Credit programs with no face-to-face component (see flat sheet):
Have you created a detailed Personal Learning Schedule to accommodate the academic rigor of this program and attached it to your application?
Yes _______ Guidance Counsellor/Off-campus Coordinator initials
2. If your program has the option of an AM or PM cohort, which is your preference? (Please note that we will do our best to accommodate but cannot guarantee preferences are met).
AM PM N/A _______ Guidance Counsellor/Off-campus Coordinator initials
3. Have you verified with your Guidance Counsellor or Off-campus Coordinator that you meet the academic requirements?
Yes _______ Guidance Counsellor/Off-campus Coordinator initials
4. Have you verified with your Guidance Counsellor or Off-campus Coordinator that you are able to commit to being on-campus for the scheduled program dates (see flat sheet)?
Yes _______ Guidance Counsellor/Off-campus Coordinator initials
5. Have you verified with your Guidance Counsellor or Off-campus Coordinator that you are able to arrange for transportation to and from the post-secondary institution?
Yes N/A _______ Guidance Counsellor/Off-campus Coordinator initials
6. Have you verified with your Guidance Counsellor or Off-campus Coordinator that you are prepared to meet the partner location’s proof of vaccination requirements?
Yes N/A _______ Guidance Counsellor/Off-campus Coordinator initials
pg. 3 Dual Credit and Exploratory Program Application Form Revision Date: October 2021
D. SUPPORTING STATEMENTS
1. Please verify you have included your Statement of Intent, explaining why this program is of interest to you and how it aligns with your career pathway, using one of the following formats (indicate the format used):
1 minute video presentation (provide the link/permission in application email submission)
myBueprint.ca - portfolio (provide the link/permission in application email submission)
written statement of intent (attached)
slide presentation with or without audio (attached)
2. Please verify you have included your Statement of Support from a teacher, Guidance Counsellor or Off-campus Coordinator. This statement should be completed by a staff member who knows you well, can refer to your future goals and how this program fits with your learning plan.
Yes, attached
E. REQUIRED SIGNATURES
I acknowledge that my child has applied for a Dual Credit or Exploratory Program.
I acknowledge that delivery of the program requires sharing of personal information (name, email, photo)
with program partners, who are bound by the FOIP Act.
I acknowledge that program partner locations require proof of vaccination (or an approved medical
exemption) for all students on-site and am prepared to provide such documentation to the program partner directly (if applicable). If my child is unable to provide such proof, they will be unenrolled from their Dual Credit or Exploratory program and will need to arrange alternate learning with their home high
school.
Student ____________________________________________ ___
Parent/Guardian (unless independent student) _____________________________________ __________
Guidance Counsellor/ Off-campus Coordinator (primary contact) ________________________________________
Independent Student Status (ONLY fill in if under 18 and declaring Independent Status)
Students under 18 years of age may be designated as Independent by the Principal if they meet certain criteria.
As a student, are you under 18 and wishing to declare Independent Status?
Yes. Principal’s Signature (Home High School) ______________________ _________________ ___
pg. 4 Dual Credit and Exploratory Program Application Form Revision Date: October 2021
F. APPLICATION CHECKLIST and ATTACHMENTS Please complete the following checklist before submitting your application and scan all attachments with your application to be submitted as one pdf file.
I have included (in this order):
A. Student Information (fill in this section digitally)
B. School Information (fill in this section digitally)
C. Application Verification
D. Supporting Statements - Statement of Intent (attached)
D. Supporting Statements – Statement of Support (attached)
E. Required Signatures
Acknowledgement of Risk Form
Medical Information Form
Consent for CBE Use of Student Information (optional)
Consent for Use of Student Information by News Media and Outside Groups (Third Party) (optional)
Student High School Transcript (DAR) – found in myBlueprint.ca or mypass
Email all required documents as one PDF file in the order outlined above to:
A confirmation email with be sent using the CBE Student EDU email upon receiving your complete application package. If you have not received a confirmation email within 1 week of your submission, please contact us at [email protected]
Personal information is collected under the authority of the Education Act, the Student Record Regulation and Alberta’s Freedom of Information and Protection of Privacy Act (FOIP). This information w ill be used for enrolling students in Off -Campus Education programs. It w ill be treated in accordance w ith the privacy protection provisions of the FOIP Act. If you have any questions about the collection or its intended use, c ontact Off-Campus Education,
Calgary Board of Education, 1221 8 St SW, 403-817-7516.
September 2020
Page 1 | 4 CAN: 26911424.3
Off-campus Education Acknowledgement of Risk
Consent of Parent, Guardian or Independent Student and “Acknowledgement of Risk”
PLEASE READ CAREFULLY
I,_ , the parent or legal guardian of (name of student) (“my
child”), agree to the participation of my child OR I, (name of student), an “Independent
Student” under the School Act (Alberta), agree to my participation in the Program, including any
practicum or workplace training that is part of the Program or ancillary to it organized by The Calgary Board of Education (“CBE”) with
(the “Program Provider”).
In consideration of the CBE accepting my child as a participant in the Program or accepting me (as an Independent Student) as participant in the Program, I agree and acknowledge as follows:
1. The CBE reserves the right to cancel the Program in whole or part, including prior to the scheduled date of commencement, based upon the security, health and safety conditions in the location(s) of or in the vicinity of the location(s) of the Program.
2. A) I agree, for myself and on behalf of my child, to release the CBE, its Trustees, Superintendents, employees, volunteers,
contractors and consultants and the Program Provider and its respective directors, governo rs , officers, employees and agents (collectively, the “Releasees”) from any claims, losses, damages, liabilities and costs (“Losses”) that I or my child, as the case may be, may incur arising from or in connection with the Program, except to the extent any such losses, damages, liabilities and costs arise directly from the negligence or wilful acts or omissions of any of the Releasees. I acknowledge that none of the Releasees shall be responsible for any consequential, incidental, special or punitive losses, damages or costs incurred by me or my child arising in respect of the Program.
B) Without limiting the generality of Section 2(A) above, I, for myself and on behalf of my child, or I, an Independent Student,
release the Releasees from any delays, acts or omissions of any of the Releasees in respect of the Program arising from events beyond his, her, its or their reasonable control, which includes but is not limited to ACTS OF GOD, WAR, STRIKES OR GOVERNMENT RESTRICTIONS, TERRORIST ACTIVITIES, STRIKES OR WORK STOPPAGES, OR THE ACTS OR OMISSIONS OF ANY OTHER ORGANIZATION OR INDIVIDUAL, OVER WHOM THE RELEASEES HAVE NO DIRECT CONTROL.
C) I agree, for myself and on behalf of my child (or I, an Independent Student, agree) to pay or reimburse the Releasees for any
claims, losses, damages and costs arising from any acts or omissions of my child (or of me, as an Independent Student) in connection with the Program resulting or arising from failure to comply with any directions or instructions given by any of the applicable Releasees.
3. I, on behalf of myself and my child (or I, as an Independent Student) release the Releasees and each of them from any losses,
liabilities, damage and costs that I and/or my child may incur arising from and during the course of transportation to and from the location(s) of the Program, including in the course of embarking or disembarking from the mode of transportation. I confirm and acknowledge that any injury, damage or loss incurred during the course of transportation to and from the location(s) of the Program will not be compensated by the Releasees.
4. I freely and voluntarily acknowledge and assume on my behalf and on behalf of the Student (or, as an Independent Student, I assume)
all of the risks and hazards, known and unknown, inherent in the nature of the Program and I understand and acknowledge that a Student may suffer personal and potentially serious injury, loss or illness due to unforeseeable or unexpected events.
5. I am satisfied that I have been provided with information about the Program, including the nature and extent of certain risks and
hazards associated with the Program and that such information concerning risks and hazards is NOT exhaustive. I am not relying solely upon such information provided by the CBE and reserve the right to obtain additional information upon such basis as I determine.
September 2020
Page 2 | 4 CAN: 26911424.3
6. I freely and voluntarily acknowledge and assume on my behalf and on behalf of my child (or I, as an Independent Student, acknowledge and assume) all of the risks and hazards, known and unknown, inherent in the nature of the Program and I understand and acknowledge that any participant in the Program may suffer personal and potentially injury, loss or illness due to an unforeseeable or unexpected event as a result of any such hazard, known and unknown. Without limiting the foregoing, I acknowledge that part of the Program may involve the placement of my child (or, as an independent student, my placement) by the Program Provider in "practicum" assignments that involve workplace interactions with members of the public (for example, if a practicum assignment is with a veterinarian health care facility, my child - or I, as an Independent Student - will interact with members of the public who own animals and with animals, will have limited exposure to the medical application of pharmaceuticals and drugs or may be required to obtain vaccinations/inoculations in order to participate in the practicum). I agree on behalf of my child (or I agree, as an Independent Student) to assume the foreseeable and unforeseeable risks arising from placement in a practicum assignment as part of the Program.
7. My child has been informed by me that he/she shall comply (or I, as an Independent Student, confirm that I shall comply) with the CBE’s policies and regulations and any applicable CBE or school Code of Conduct, and with any rules of the Program Provider in respect of the Program made known to me and/or my child, as well as with the directions and instructions of the CBE’s employees, consultants, volunteers or Program Provider personnel concerning the Program. Participation in the CBE and/or Program Provider preparatory sessions and meetings (if any) prior to the activities is mandatory. I acknowledge that failure to do so may result in the exclusion of my child (or of me as an Independent Student) from the Program by the CBE.
8. If my child (or I, as an Independent Student) becomes ill or incapacitated, I acknowledge and agree that the CBE, its employees, consultants and volunteers and also in the case of medical emergency, the Program Provider personnel, may take any actions they deem necessary, including securing professional medical treatment. I also acknowledge that the CBE and/or Program Provider personnel shall make reasonable efforts to contact the parent or guardian of a Student (who is not an Independent Student) in any medical emergency situation.
9. I have completed the medical information form (attached). I warrant that the medical information I have provided is complete and up to date. I consent to CBE sharing the medical information with the Program Provider and its applicable personnel. I have disclosed any known medical information concerning my child (or concerning me as an Independent Student) that may affect participation in the Program. I also acknowledge and agree that CBE or the Program Provider may refuse to accept my child for or may remove my child (or me as an Independent Student) from participation in the Program as a result of any medical condition as CBE or the Program Provider shall determine, at its sole discretion.
10. I understand that I am solely responsible for any illegal activities of my child (or, as an Independent Student, my illegal activities) during the Program (such as theft, vandalism or using or trafficking in any illegal substances or non-prescription drugs).
11. I confirm that this form shall be binding upon me as an Independent Student or upon me and the other parent or legal guardian of my child and upon my child and if the other parent or guardian of my child shall commence any action or claim against any of the CBE Group in respect of the matters herein notwithstanding the provisions hereof, I indemnify the CBE Group from any losses, damages, liabilities and costs incurred by the CBE Group or any of them in that regard.
12. I am at least 18 years of age and confirm that I have had the opportunity to seek independent legal advice prior to signing this form.
13. I confirm that this form and my acknowledgements and agreements are governed by the laws of Alberta.
Signed at Calgary, Alberta this ____________, 202_____
____________________________________________ Signature Parent/Legal Guardian/Independent Student
____________________________________________
Print Name
Address and Telephone Number
CONSENT IS VALID FOR ONE SCHOOL YEAR ONLY June 2021
Consent for CBE Use of Student Information
Please complete and return to the school
When student information is shared in a way that makes the child or student publicly identifiable, the Freedom of Information and Protection of Privacy Act (FOIP) requires the Calgary Board of Education (CBE) to obtain parent consent. Sharing this information, for non-profit educational purposes, celebrates the successes of children and students with parents, the community, and general public.
When you sign this form, you are agreeing that some of your child’s personal information(image, first name, first initial of surname, grade, school, and/or samples of work) may beshared publicly by the school and/or CBE. Student personal information is shared for thepurposes of ongoing communication, learning, and celebration. Examples of such sharinginclude: public displays and presentations CBE approved, including teacher managed, websites and social media sites. print and electronic publications such as school newsletters, brochures, and invitations
Lessons and student work may be digitally recorded as evidence for student assessment, staff development or to demonstrate good professional practices. These recordings may be shared with other educational organizations or colleagues as a professional learning resource.
Parents or independent students are under no obligation to consent; it is their voluntary decision to do so. If you do not return this form, this indicates that consent was NOT given.
Decisions on consent can be changed at any time throughout the school year. You may withdraw your consent or decide to provide consent at any time by notifying the school principal in writing. The change to consent will be effective going forward from the time the notification is received.
Note | If you have any concerns about this form, please contact the principal at your school. Note | If you have any concerns about this form, please contact the principal at your school.
Consent for Release
I give the Calgary Board of Education consent to use my child’s information as described above for non-profit educational purposes.
I DO NOT give consent to use my child’s information as described above.
__________________________________ _________________________________________ Name of Student (please print) School
_________________________________ _________________________________________ Name of Parent/Independent Student Signature of Parent/Independent Student
Authorization for Collection of Personal Information Personal information is collected under the authority of the Education Act and the Freedom of Information and Protection of Privacy Act. This information will be used to manage student personal information. If you have any questions regarding the collection of this information, contact the school principal.
cbe.
ab.c
a
Consent for Use of Student Information by News Media and Outside Groups (Third Party)
Please complete and return to the school.
News media outlets (TV, radio, print publications) and other organizations (third parties) may visit schools throughout the year to report on school programs, activities, and achievements. This is done with permission from school administration and is supervised by CBE staff. Parents will be notified whenever third parties will be attending or have attended events or activities. Information gathered at these events becomes public and may be published, broadcast, sold to other media outlets, or posted on websites and social media by the third party. The CBE cannot control or prevent the distribution or use of student personal information once it is made public. When you sign this form, you are agreeing that some of your child’s personal information (image, first name, initial of surname, grade, and/or school name) may be shared with third parties at school events, activities or non-public events when third parties have been invited, including media. Parents or independent students are under no obligation to provide consent; it is their voluntary decision to do so. If you do not return this form, this indicates that consent was NOT given. Decisions on consent can change any time throughout the year. You may withdraw your consent or decide to provide consent by notifying the school principal in writing. The change to consent will be effective going forward from the time the notification is received. The CBE is unable to control who is taking recordings at public events. Public events include such activities as school assemblies, performances, field trips and sporting events. Note | If you have any concerns about this form, please contact the principal at your school. Consent for Release
I give the CBE consent to include my child in the media/third party coverage as described above.
I DO NOT give consent for my child or me to participate in media/third party coverage as described above.
__________________________________ _________________________________________ Name of Student (please print) School _________________________________ _________________________________________ Name of Parent/Independent Student Signature of Parent/Independent Student
CONSENT IS VALID FOR THE CURRENT SCHOOL YEAR ONLY Authorization for Collection of Personal Information Personal information is collected under the authority of the Education Act and the Freedom of Information and Protection of Privacy Act. This information will be used to manage student personal information. If you have any questions regarding the collection of this information, contact the school principal.
cbe.ab
.ca
Consent for Use of Student Information by News Media and Outside Groups (Third Party) June 2021
Frequently Asked Questions Why is consent required? The sharing of student personal information in ways that identify the student is governed by the Freedom of Information and Protection of Privacy Act (FOIP) and requires CBE to obtain permission under certain circumstances. CBE requires parental or independent student consent for CBE staff to share student information for educational purposes, outside of CBE. Examples of this include posting student work or images on CBE websites, Facebook or other social media. This consent is provided on the “Consent for CBE Use of Student Information” form CBE also requires parental or independent student consent to allow third parties (such as media or business partners) to photograph, video or interview students at CBE non-public events. This consent is provided on this form. How long is my consent valid for? Parental or independent student consent is gathered annually and is valid for the current school year only. What happens if I change my mind regarding consent? Parent or independent student consent can be withdrawn at any time during the school year. This must be done in writing to the school principal. Please keep in mind that once personal information, images or student work are released in any public forum, the CBE cannot control or prevent further distribution or use of the material. Parents or independent students can also change their mind to provide consent during the school year. If you change your mind and wish to provide consent during the school year, it must be done in writing to the school principal. What happens when the media comes to school? If your child has consent, they may be recorded by the media. If you have not provided consent, your child will not be allowed to be recorded or approached by the media on CBE property.
First Nations – Non-Status Inuit
Section I Personal Data
Section II Course Selection
Online Dual Credit Registration Form
Legal Last Name: Legal First Name: Middle Name:
Preferred Name: Former/Maiden Name (if applicable):
Mailing Address: City: Province:
Postal Code: Home Phone: Cell Phone:
School Email Address: Birthdate (mm/dd/yyyy):
Gender: Female Male Other Alberta Student Number (ASN):
Immigration Status:
Domestic Applicant International Applicant
Canadian Citizen Country of Citizenship:
Permanent Resident - Country of Citizenship:
Refugee - Country of Citizenship:
First/Native Language:
Please indicate the dual credit course(s) you are registering for:
Winter 2022 HAT 1255 – Global and Sustainable Tourism
AHT 1140 – Veterinary Practice-The Team Connection
ATG 1008 – Solving Technology Problems
HORT 1700 Producing Horticulture Crops
SPM 1260 – Introduction to Sports Management
EVS 1210 – Applied Ecology
Indigenous Ancestry – This information is being collected on behalf of Advanced Education and Technology, pursuant to Section 33(c) of the FOIP Act as the information relates directly to and is necessary to meet its mandate and responsibilities to measure system effectiveness over time and develop policies, programs and services to improve Indigenous learner success. For further information or if you have questions regarding the collection activity, please contact the office of the Director, Post-secondary Planning and Accountability, Adult Learning Division, Alberta Advanced Education and Technology, 10155 102 Street, Edmonton, AB T5J 4L5 (780) 422- 1209. If you wish to declare that you are an Indigenous person, please specify:
First Nations - Status Métis
Section III Voluntary Disclosures
Section V Dual Credit Agreement
Freedom of Information and Protection of Privacy
The information collected on this form is collected for the purpose of the dual credit program under the authority of the Post SecondaryLearning Act, the School Act and the Freedom of Information and Protection of Privacy Act. The information will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta. If you have any questions about the collection and use of this information, please contact the Dual Credit Coordinator at 403-507-7731.
PRINT NAME OF STUDENT SIGNATURE OF STUDENT DATE
PRINT NAME PARENT/GUARDIAN SIGNATURE OF PARENT/GUARDIAN DATE
Name:
High School: School District:
Part 1 – STUDENT
By signing this agreement, I acknowledge my understanding that I am enrolled in a college level course and that my work will be graded according to the same standards applied to college students. I understand that the final grade earned in this course will be entered into my permanent record at Olds College. As an Olds College dual credit student I understand and agree to the following:
Participate in online training as required. You must contact your instructor if you will be unable to meet any deadlines. Meet program expectations. Intent to withdraw from the college at any time will require the completion of Olds College Withdrawal Form and your school district
submitting it to the Director of the Community Learning Campus.
A “W” grade will be assigned to the course in the current registration period providing you have submitted the withdrawal form. Withdrawals will be accepted until the last day of the course.
In signing this application, I agree to abide by the rules and regulations governing study with Olds College and the school district.
I declare that the information contained in this application is complete and correct. I understand that information about my registration and course progress will be shared between the school district and the college. I understand that this application does not guarantee admission to Olds College programs and is subject to the availability of seats. I understand that this is a school district partnership and agree that the school district and college reserve the right to modify the program without notice or prejudice.
PRINT NAME OF STUDENT SIGNATURE OF STUDENT DATE
Section IV FOIP
Part 2 – PARENT/GUARDIAN PERMISSION
I authorize my child’s participation in Olds College course(s). I give permission for Olds College to share information about course progress and registration with the school district, so that the school may report as per high school reporting requirements.
I declare that the information contained in this application is complete and correct. I understand that this application does not guarantee admission to Olds College programs and is subject to the availability of seats. I understand that this is a school district partnership and agree that the school district and college reserve the right to modify the program without notice or prejudice.
PRINT NAME (PARENT/GUARDIAN) SIGNATURE (PARENT/GUARDIAN) DATE
Part 3 – SCHOOL DISTRICT DUAL CREDIT CONTACT
I have discussed the dual credit course with this student and I recommend him/her as a candidate for admission.
PRINT NAME (SCHOOL DISTRICT CONTACT) SIGNATURE (SCHOOL DISTRICT CONTACT) DATE
EMAIL ADDRESS (SCHOOL DISTRICT CONTACT)
TEACHER MONITORING STUDENT LEARNING (IF DIFFERENT FROM SCHOOL CONTACT) EMAIL ADDRESS
Part 4
Please email the fully completed form to [email protected]
