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2010 January Short Term Independent Proposal & Contract
Please complete this form by typing in the expandable grey text boxes.
This form serves as an independent project proposal and a contract, which will be subject to approval by the January
Short Term Committee. It will be presented to the Committee as a proposal first. After the Committee approves the
proposal, it will then become a binding contract upon receipt of the appropriate signatures. If the contract is denied
by the committee, the committee will advise you on what to do to receive approval. If you do not make the
recommended changes in the time given, your proposal will be denied and you will need to pick a new project.
In the space below, please type a detailed description of your project.
List all locations where your project will be held, i.e., museums, your house,
business address, out-of-state/country, etc.?
If you are going out of town or out of the country, please provide the name, address,
telephone number and email address of the person you’ll be staying with.
Do you have any prior experience with this project? If yes, please indicate what
experience you have. If not, please indicate you have no prior experience. (Note:
Experience is NOT necessary for JST Committee approval.)
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Please, explain why you wish to do this particular project.
List your learning goals and what you expect to accomplish by the end of your JST
If you are proposing a project with other students, please describe your individual
role within the group. What are you personally responsible for doing?
You are required to write a daily journal. Do you plan to submit something
additional? (Ex.: models, photographs, drawings, maps, audio/videotapes, CDs,
exhibits, a live performance, scrapbook etc.)
If yes, please indicate what you will be submitting.
Please complete the calendar below by describing what activities you are proposing to do, and what you
expect to accomplish each day. List your location, activities, lessons, meetings, etc. The calendar
represents everyday January Short Term is in session. Again, the more detail you give to the committee,
the easier it will be for the committee to make an informed decision about the viability of your project.
JST Daily Schedule
Tuesday, January 19
Wednesday, January 20
Thursday, January 21
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Friday, January 22
Monday, January 25
Tuesday, January 26
Wednesday, January 27
Thursday, January 28
Friday, January 29
Monday, February 1
Tuesday, February 2
Wednesday, February 3
Thursday, February 4
Do you usually ride the school bus? No Yes
Will you ride the Roycemore bus for JST? No Yes Wk 1 Wk 2 Wk 3
Will you eat lunch at school? No Yes Wk 1 Wk 2 Wk 3
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The project director and student will complete the following section together.
Your duties as a Project Director include:
Reading the JST Booklet and other materials for program goals and rules.
Planning for and scheduling at least 4-5 hours daily of meaningful activities.
Supervising and overseeing students throughout the project, or delegating
supervision to another qualified person in your organization.
Meeting with the student on a regular basis.
Reviewing the student’s journal at least every other day.
Informing the JST Coordinator at least one week prior to the end of JST if a
student is in jeopardy of not successfully participating in their project.
Writing an evaluation of student and the project they have completed.
As the project director what skills or experience can you share with our student to
help him/her with this project?
I will be acting as a project director for (student’s name), and I agree to
complete the above mentioned duties.
Or, I will be delegating the duties and responsibility for the above mentioned
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A contract is a binding agreement between two or more persons. All signatures below by student,
parent/guardian, advisor and project director means agreement to the project here described and to rules
specified in the JST Booklet. Everyone agrees to notify the school of all absences, schedule changes,
logistical difficulties, and performance problems affecting the project in any manner.
Project Director ___________________________________ Date _____________
Student __________________________________________ Date _____________
Advisor ___________________________________________ Date _____________
Parents/Guardians – My signature validates that I agree to the following:
1) I have read the JST Booklet to understand program goals, rules and operation.
2) I will pay all project fees by December 3, 2007 unless otherwise arranged with the project director.
3) If applicable, I will complete and submit any other necessary forms in a timely manner.
4) My child will not go on college visits, vacation or non-emergency appointments during his/her JST project
Parent/Guardian _______________________________ Date_____________