Burnt River Distance Education Application

Burnt River Distance Education Application

STUDENT SECTION Student Name: Birth Date: / / Sex: Male Female Address: City: State: Zip: E-Mail (student): Cell Phone: ( ) - Home Phone: ( ) - Current School: Past Schools: Last Grade Attended: 8 th 9 th 10 th 11 th 12 th ****Please attach current transcripts and any documentation from state assessment**** Grade enrolling: 9 th 10 th 11 th 12 th When do you want to start? Immediately Within the current term Next Term Next Year Please rate yourself in the following areas: Academic achievement Excellent Above Average Average Below Average Interpersonal skills Organizational/Planning skills Independent thinking Honest/Trustworthy Self-discipline Flexibility Reliability Creativity Follow-through Do you have any experience with v-tel classes or online classes? If so please describe. Do you have access to a computer with at least 1 mb of bandwidth? Please answer the following essay questions. 1. Describe yourself: What are your goals? What do you want to become? 2

2. Why do you want to attend Burnt River? What motivated you to choose our school? 3. What school subjects interest you and why? 4. Describe how you communicate and work with teachers and other students. 3

PARENT/GUARDIAN SECTION Parent/Guardian: Home Phone: ( ) - Work: ( ) - Cell: ( ) - Address: City: State: Zip: E-Mail (Parent/Guardian): Other Parent/Guardian: Home Phone: ( ) - Work: ( ) - Cell: ( ) - Address: City: State: Zip: E-Mail (Other Parent/Guardian): The answers to these questions will help our teachers provide students with the best possible educational experience. Why do you want your child to attend Burnt River? What motivated you to choose our school? What are your child s strengths and weaknesses? If your child is accepted into the program how do you plan on supporting them in their pursuit for education? Please list special services or programs your child is currently receiving or needs to receive. If your child is under a current or pending expulsion, please explain the circumstances. 4

PARENT/GUARDIAN PLEASE READ THIS SECTION WITH YOUR CHILD BEFORE CHECKING EACH BOX AND SIGNING BELOW. Burnt River School is a public charter school that provides instruction both locally and online. We are committed to the success of all of our students. Our students are provided a rigorous curriculum that allows for independent and cooperative learning with local students and online students alike. Although our online high school uses the same rigorous curriculum, it does so with new and emerging distance learning technologies to provide personalized instruction. Burnt River Online School will be able to meet the needs of an assortment of 21st century students by providing them with personal individualized instruction that focuses on skills such as self-directed learning skills, innovative technology literacy, time management and personal responsibility. Unique to Burnt River Online School is that students will be able to get face to face contact and seat time with our highly qualified instructors through a variety of emerging technologies. All of these elements make Burnt River Charter School an excellent choice for a high quality education I understand that submission of this application does not guarantee admission to Burnt River, and that every applicant has equal opportunity to receive services if they meet the grade and age requirement. I understand that false or misleading information on this application will result in this application not being accepted or revoked. I understand that if more applications are received than spaces are available that a lottery will be conducted to fill the spaces as specified by Oregon Law. I understand that all applicants will be notified by phone and mail of the applications status in a timely manner. I endorse my child s application to Burnt River with the understanding that if my child s application is accepted I will support my child with his/her classes. I understand that if accepted, my child (the student) will have to abide by the rules outlined in the Burnt River student handbook. Parent/Guardian Signature Date Student Signature Date *Please mail this application to: Burnt River Charter School, P.O. Box 9, Unity, OR 97884 ** For questions please contact Burnt River Charter School: (phone) 541-446-3336, (fax) 541-446-3581 Non-Discrimination Policy: Burnt River School District does not discriminate on the basis of race, religion, color, national origin, disability, marital status, sex, sexual orientation or age in providing education or access to benefits of education services, activities and programs in accordance with Title VI, Title VII, Title IX and other civil rights or discrimination issues; Section 504 of the Rehabilitation Act of 1973, as amended; the Americans with Disabilities Act; and the Americans with Disabilities Act Amendments Act of 2008. 5