Adopted: April 1999
Revised: October 2021
Complete page 1 of this application and return it no less than one month prior to the first day of the course(s) requested: Director of Community Education, 15180 Canada Avenue, Rosemount, MN 55068.
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GENERAL INFORMATION - print |
student name date of birth
parent/guardian name(s)
address city/zip
home phone cell phone work phone email address
District 196 school attendance area (if applicable)
I have read Administrative Regulation 640.2.2AR, Home School Shared Time Students in Middle School and High School Curricular Courses: □ Yes □ No
X
signature of parent or guardian (or student if 18 years of age or older) date
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DISTRICT 196 COURSE(S) REQUESTED |
School Year: 20 - Grade
Course
For: □ 1 □ 2 □ 3 Trimester OR □ 1 □ 2 □ 3 □ 4 Quarter
Course
For: □ 1 □ 2 □ 3 Trimester OR □ 1 □ 2 □ 3 □ 4 Quarter
At middle school checked below:
□ Black Hawk
□ Dakota Hills
□ Falcon Ridge
□ Rosemount
□ Scott Highlands
□ Valley Middle School of STEM
At high school checked below:
□ Apple Valley
□ Eagan
□ Eastview
□ Rosemount