Independent Study Forms
In order to participate in an Independent Study, I had to fill out the following forms (an application and learning contract):
Independent Study Application
Independent Studies allow students flexible learning environments and pathways to pursue individual, interest-based learning experiences beyond the walls of our school. Students participate in curriculum outside of the school's course offerings. Students are expected to be highly self-directed and compile evidence of learning to meet graduation proficiencies.
Application Process:
- Meet with a house counselor to discuss your plans.
- Meet with independent study teacher to submit this Independent Study paperwork (this form).
Student Name: _______________________________ YOG:______________
House Counselor Signature: ________________________________________________
Advisor Signature: ________________________________________________________
Project Title: ____________________________________(for transcript)
Credit Requested: ________credits in: ____________________(subject area).
Start date: _______________ End date (expected):_________________
Site/Place of learning (if not at school): _______________________________________________
Contact Name: ______________________________ email____________________________
Phone # _______________________ Contact Signature:_______________________________
- Explain your Independent Study experience as specifically as you can:
- What aspects of this topic/discipline are most interesting to you and why? What are you most excited about in this work?
- How will your work be new for you? OR How will it extend or build on things you already know or do?
- Please articulate 2-3 “guiding questions” for this experience. Is there a problem you are exploring or trying to solve?
- To earn credit you must show evidence of your learning through a weekly blog post or a biweekly meeting with your Teacher of Record. You must also document your learning experiences in your online learning portal. You may choose from the following options or propose your own choices for documentation:
- Documents and/or notes
- Website
- FlipGrid videos
- Tangible product
- Presentation
- Photos
Certificates
I understand that in order to earn credit for an Independent Study I must:
● Complete IS application and contract (this form).
● Complete weekly blog posts or bi-weekly meetings with: _________________________ (Personalized Learning Teacher) to show reflection and progress toward goals.
● Document evidence of learning/project work in my online learning portal.
● Present evidence and reflection of learning to the school community. (e.g. exhibition night, panel presentation, roundtable meeting etc.)
Students enrolled in an Independent Study have one month from the project state date to withdraw, otherwise if they do not complete their project by the agreed upon end date a “W” (withdrawn) will appear on their transcript. To drop or withdraw from an Independent Study students must see their guidance counselor to complete paperwork.
________________________________ _____________________________
Student Signature Parent Signature
Date ________________________
Independent Study Learning Contract
STUDENT NAME: YOG:
HOUSE: STUDENT PHONE:
TRANSCRIPT:
PROJECT WORK OUTLINE:
Meet with your learning team to fill out the contract below. Remember, each project must include the following components:
● Evidence of new content knowledge and/or skill development
● Reflection on learning and process
● A final demonstration of learning at the end of the project.
Learning Targets my project is tagged to: (at least 4 required)
Student Will:
Teacher Will:
Time-line(s) & Final Deadline:
Sketch out your DRAFT calendar for this work:
Upon completion and submission of the work above I will receive _________________ credit in ___________________________________ (curricula area).
_________________________________________ ________________________
Student Signature Date
_________________________________________ ________________________
Parent Signature Date
_________________________________________ __________________________
Teacher of Record Signature Date