iq Academy Minnesota 2300 Corporate Park Dr. Ste 200 Herndon, VA 20171 Ph. 1.877.994.4766 opt# 3 Fx. 1.877.397.6810 www.iqacademymn.org Part-time Enrollment Forms Packet (EFP) Please use this coversheet to reference all the forms and information needed to complete this step in the enrollment process. Based on your student(s) grade and applicable circumstances, you are required to submit documentation outlined below. You can fax, scan and e-mail, or mail the required paperwork (Please send copies, do not mail the original documents.) Fax (preferred): Scan and Email: Mail: 1-877-397-6810 iqminnesotafax@k12.com iq Academy Minnesota 2300 Corporate Park Dr. Ste 200 Herndon, VA 20171 Reminder: You must create an account with K12 before submitting paperwork (https://myaccount.k12.com) *Please save your account login information in a safe place you will use later to start school Required For? Item Description Provided by? ALL Part-time Students Part-time Student Contract MDE Online Learning Supplemental Notice of Registration The student and parent/guardian must complete and sign this form. The student, parent/guardian, and enrolling district counselor must ALL complete and sign this form. *Legal Guardian paperwork must be submitted if someone other than the parent is signing forms *Incomplete applications will not be processed (i.e. missing signatures, courses or MARSS#) In Packet completed by You In Packet completed by You and Enrolling District Counselor Before completing the forms contained in this packet, please be aware of the following guidelines restricting part-time enrollment. 1. A student must be enrolled full-time in another Minnesota public school to be eligible for part-time enrollment in iq Academy Minnesota. (students cannot be enrolled in a private or home school setting and take part-time courses through iq Academy Minnesota without paying tuition) 2. Courses taken at iq Academy Minnesota must be taken in place of courses in the enrolling school district (no credit recovery) 3. iq Academy Minnesota is responsible for providing the course and the instructor for part-time students. All other responsibilities (special education services, truancy violations, credit assignment on official transcripts, state assessments, etc.) fall on the enrolling school district. 4. Part-time students are not eligible to receive an iq Academy Minnesota diploma, credits earned will be transferred back to the enrolling district. 5. iq Academy Minnesota reserves the right to cancel any course offering is fewer than 10 students choose to enroll in the course. iq Academy Minnesota will promptly contact any student that is affected by a course cancelation due to low enrollment. Student s Name: Student s Home Phone: 1
iq Academy Minnesota 2300 Corporate Park Dr. Ste 200 Herndon, VA 20171 Ph. 1.877.994.4766 opt# 3 Fx. 1.877.397.6810 www.iqacademymn.org Part-time Student Contract iq Academy Minnesota (IQMN) provides students an opportunity to participate in online learning on a part-time basis. Because online learning represents a non-traditional learning experience, there are certain expectations that students and parents must agree to before enrolling in courses delivered online. This contract is intended to outline iqmn program part-time expectations for students, parents and the enrolling school district. A copy of the iq Academy Minnesota Handbook referenced below can be found online at: www.iqmn.org/handbook As a student and parent enrolling in the IQMN program, I am aware that I am expected to comply with the following policies and procedures set forth in the Student Handbook: 1. Enroll in courses approved by enrolling school district counselor. 2. When enrolling part-time I understand that I will be completing courses/credits that will be transferred back to my enrolling school district. The enrolling school district must agree that the course meets the district s requirements for graduation. 3. Have consistent and reliable access to a computer (part-time students are not eligible to use an iq Academy laptop) with high-speed internet access to complete online school work. 4. Communicate with appropriate language and message content as outlined in the Online Code of Conduct (School Work section of the iq Academy Minnesota Handbook.) Inappropriate use of the Internet will not be tolerated and may result in the loss of the right to participate in the iqmn program. 5. Participate in all grade level State Assessments mandated by the Minnesota Department of Education at enrolling school district. 6. Request a course withdraw up to 15 days after being assigned to the course. After the 15 day period, the course will remain in the student s schedule and a grade will be earned and reported on a transcript. 7. Attend weekly Class Connect sessions (live or recorded) that are scheduled by the teacher and could take place during the day or evening (8am to 8pm.) Participation in weekly sessions is 10% of the student s course grade. 8. Communicate changes in contact information such as phone, address, or e-mail to the IQMN office immediately. 9. Maintain regular weekly attendance measures outlined in the Attendance and Truancy section of the handbook and participate in all courses each week. 10. Parents/guardians are expected to supervise students as part of this educational model, assuring the work is being completed on-time and adequate attendance measures are being attained on a weekly basis. The signature below is assurance that you have read and understand the policies outlined above and in the (online) Student Handbook. I agree to comply with all contract items listed above. Student Signature: Date: Parent/Guardian Signature: Date: *Legal Guardian paperwork must be submitted if someone other than the parent is signing Student s Name: Student s Home Phone: 2
Center for Postsecondary Success 1500 Highway 36 West Roseville, MN 55113-4266 O n l i n e L e a r n i n g ( O L L ) S u p p l e m e n t a l N o t i c e o f S t u d e n t R e g i s t r a t i o n ED-02400-04 GENERAL INSTRUCTIONS: The online learning supplemental notice of student registration is used to register for a supplemental online learning course from a certified public school online learning provider. Supplemental online learning means an online course taken in place of a course period during the regular school day at a local district SUBMIT the completed form to the online learning provider listed in section II. One form per student per term is required. Section I: To be completed by the parents and student after they have had initial meetings with the enrolling district and online learning provider. Please sign only after you have reviewed the online course and program and understand the expectations of enrolling in online learning. Section II: To be completed by the online learning provider and enrolling district online contact person. Each school should keep a copy of this form when all signatures have been secured. The enrolling district has 15 days to review the attached course syllabus and sign and submit the form to the online learning provider. SECTION I: IDENTIFICATION INFORMATION TO BE COMPLETED BY THE STUDENT AND PARENT OR GUARDIAN Student Name (Last, First, M.I.): Date of Birth: Gender: Student s e-mail: Student s home phone: Student s cell phone: Address: City, State Zip code: Current Grade Level: Enrolling School: Student MARSS Number: Last Grade Completed: Mother/Guardian Name (Last, First, M.I.): Mother/Guardian Address: Mother/Guardian s E-mail Address (if different from student) Father/Guardian Name (Last, First, M.I.) Father/Guardian Address: Father/Guardian s E-mail Address (if different from student): Home phone: Mother s work phone: Mother s cell phone Home phone: Father s work phone: Father s cell phone Student reason for enrolling in online learning: Course not offered at school Schedule conflict Enrichment / Advanced learning opportunity Credit recovery If so, is the course(s) being taken in addition to a full-time schedule Yes No Other (please provide reason below) Please indicate what type(s) of internet connection you will be using to access your courses: Dial-up modem Cable/DSL High Speed Home Connection High Speed School Connection No internet access I plan to participate in this course at: I have discussed enrollment in online learning with my enrolling school representative and the online learning program representative. I have reviewed the online course(s)and program listed on page 2 and understand the expectations of enrolling in online learning Student Signature: (required) Date: Parent Signature: (required for students under 18 years old) Print name and relationship:
Center for Postsecondary Success 1500 Highway 36 West Roseville, MN 55113-4266 O n l i n e L e a r n i n g ( O L L ) S u p p l e m e n t a l N o t i c e o f S t u d e n t R e g i s t r a t i o n SECTION II: OLL PROGRAM PLAN TO BE COMPLETED BY OLL PROGRAM PROVIDER AND ENROLLING SCHOOL CONTACT PERSON Online Learning (OLL) Program: Telephone: 218-998-3198 iq Academy Minnesota Fax: 218-998-3952 Online Learning Program Coordinator: E-mail address: @iqmn.org Online Learning Program Mailing Address: 601 Randolph Ave Fergus Falls, MN 56537 Enrolling School: District Number: Telephone: ED-02400-04 Page 2 Enrolling School Contact Person or Counselor: Enrolling School Mailing Address: Fax: E-mail address: OLL proposed plan for Student MARSS # (student name) OLL Courses (courses may not exceed 50% of student s full schedule) Credit Recovery Start Date Sem/Tri/Qtr. Credits Proposed completion date *Meets enrolling district s graduation requirements. Please check & initial To be completed by the enrolling district: Check one of the following: This coursework will substitute for other course work in the enrolling district and will be funded by the normal funding formula for online learning. This coursework will substitute for other course work in the enrolling district and will be funded by a contractual agreement with the enrolling district. This coursework is being taken in addition to the regular district course work and the tuition will be paid by the student. I am a private or homeschool student and will pay tuition for which I will be billed Check one of the following: Accepts credits based on MN Statue 124D.095 Enrolling district waives 50% online learning credit limit A separate agreement has been made for exceeding 50% registration limit between the OLL provider and the enrolling district. Check one of the following: The student has notified the enrolling district before the midpoint of the current term. Midpoint Date: The student has NOT notified the enrolling district before the midpoint of the current term, but we have elected to waive this requirement. The student has NOT notified our district before the midpoint of the current term, and the student is responsible for the paying of tuition Check if it applies: The student has an active IEP on file If checked please provide the following information: Special Education Case Manager Name: E-mail address: Phone The student is receiving ELL services I have shared the online learning course(s) syllabus with the enrolling district contact person. Signature of OLL provider contact person Print name and title Date (please submit to enrolling district contact person) I have reviewed the course syllabus and the course(s) checked meet the enrolling district s graduation requirements. Signature of enrolling district online learning contact person Print name and title Date notification received Date signed and returned to OLL Provider Schedule changes may not be made after the midpoint of enrolling district s term unless waived by both schools. ATTN: Upon completion submit this form to the online learning provider in section II.
Minnesota State Assessments Plan Please ask the office to refer this form to the correct staff member! This form is for communication purposes to ensure that every student taking classes from iq Academy Minnesota will be tested this spring. The student listed below is enrolled Part-Time at iq Academy Minnesota. Your district has signed a Supplementary Agreement Form stating that you would remain the enrolling district. With supplementary enrollment, Minnesota State Assessments remains the responsibility of the Enrolling District. *STUDENT PLEASE FILL THIS OUT BEFORE GIVING TO THE OFFICE! Student Name: Date of Birth: Grade: Please confirm, by signing below that the student listed above will be completing Minnesota State Assessments at your school for the 2012-2013 school year. Thanks for your cooperation, Jen Thielke Program Manager jthielke@iqmn.org Attention: DAC District Assessment Coordinator Sign Print Date Phone Number
iqmn Part Time: Student Form School & Schedule Information Please answer the following questions to help us better guide you toward academic success. NAME : GRADE : Local School Name & Address: Local School Counselor Name: Local School Counselor Phone: iq Academy MN Courses: Semester 1: Semester 2: 1 1 2 2 3 3 4 4 5 5 Where and when do you plan to complete (most) of your online school work each day? What type of computer do you plan to use to complete (most) of your online school work? What is the best time of day to reach you if we need to contact you and what number should we call? Time: Contact Number: