Series 640.2.2P - Application for Shared-Time Enrollment of Home School Students in Middle School or High School Curriculum Courses
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.
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
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
FOR DISTRICT USE ONLY
VERIFICATION
According to our records, or as verified by the resident district of a nonresident student, the student listed on page 1 is a home school student in compliance with the Minnesota Compulsory Instruction Law.
X
signature of Director of Community Education (resident students) date
or Director of Secondary Education (non-resident students)
PRINCIPAL’S RECOMMENDATION
□ Accept this application □ Do not accept this application
Conditions for acceptance (if any):
Reasons for rejecting application:
X
signature of Principal date
DIRECTOR OF SECONDARY EDUCATION
□ Preliminary approval of principal’s recommendation
□ Preliminary disapproval of principal’s recommendation
□ Space available – student permitted to enroll in the following school
Course(s) (specify):
at Middle School/High School
X
signature of Director of Secondary Education date
c: Home School
Middle School or High School Principal
Director of Community Education
Student Information Supervisor (if application is approved)
Procedure/640.2.2P/10-8-21