JEFFERSON COUNTY EDUCATIONAL SERVICE CENTER - DOC

Document Sample
JEFFERSON COUNTY EDUCATIONAL SERVICE CENTER - DOC Powered By Docstoc
					                             JEFFERSON COUNTY EDUCATIONAL SERVICE CENTER
                                    VIRTUAL LEARNING ACADEMY                                           Revised 8/4/10
 ____ New Full Year
                                     APPLICATION TO ENROLL
 ____ Already enrolled
                                        2010-2011 SCHOOL YEAR
 ____ Summer School
District Representative: Please complete the VLA Application and then submit to the address below.
JCESC is not responsible for ensuring that the classes chosen are those needed by the student for graduation.

Name of Student:___________________________________________________________________________

Name of Parent: ____________________________________________________________________________

Address: __________________________________________________________________________________
                                 street                                  city              state             zip

Phone: _____________________________________________                      Grade: _____________________________

School district: _____________________________________________________________________________
                          District                       Building                 City                  County

   Check here if student enrolling has a current IEP. Please enclose a copy of IEP with application.

THIS SECTION NEEDS TO BE COMPLETE IN ORDER TO ENROLL A STUDENT.
Please list the name of the Point of Contact who will be responsible for this student.

__________________________________________               ________________________________________
Point of contact                                         Point of contact’s email address (required)

__________________________________________               ________________________________________
Point of contact phone number                            Point of contact fax number


                                          AUTHORIZING SIGNATURES
_______________________________                                     ______________________________
Principal Signature                                                 Date

_______________________________                                     ______________________________
Superintendent Signature                                            Date

_______________________________                                     ______________________________
Student Signature                                                   Date

_______________________________                                     ______________________________
Parent Signature                                                    Date

Please fax to: (740) 282-1677
Jefferson County Educational Service Center
ATTN: VLA Coordinators                                                           FOR OFFICE USE:
2023 Sunset Blvd.                                                                E  I DB     T     LB               O
Steubenville, OH 43952
                                                                                           #F    $35
740-283-3347 (phone)
                                                                                           #S    $40
                                                                                                 $50
Please place a check on the line next to the desired course. Write the first and last name of the assigned teacher next to each course, or write JCESC teacher.

COURSE                             EMIS CODE                      TEACHER                      COURSE                               EMIS CODE                        TEACHER
2nd GRADE                                                                                      12th GRADE
___ *Eng/LA 120 (1)                  050152       __________________ Teacher                   ___ ENG/LA IV (1)                    050190         __________________ Teacher
___ *Math 120 (1)                    110003       __________________ Teacher                   ___ Advanced Math (1)                110099         __________________ Teacher
___ Social Studies 120 (1)           151209       __________________ Teacher                   ___ Citizenship (1/2)                152100         __________________ Teacher
___ Science 120 (1)                  132110       __________________Teacher                    ELECTIVES – These courses can be taken at any grade level.
3rd GRADE                                                                                      ENGLISH/LANGUAGE ARTS
___ Eng/LA 130 (1)                   050152       __________________ Teacher                   ___ Short Stories (1/2)          059999          __________________ Teacher
___ Math 130 (1)                     110003       __________________ Teacher                   ___ Poetry (1/2)                     059999         __________________ Teacher
___ Social Studies 130 (1)           151209       __________________ Teacher                   ___ Greek Mythology (1/2)            059999         __________________ Teacher
___ Science 130 (1)                  132110       __________________ Teacher                   ___ Roman Mythology (1/2)            059999         __________________ Teacher
4th GRADE                                                                                      SCIENCE
___ Eng/LA 140 (1)                   050154       __________________ Teacher                   ___ Integrated Science (1/2)         139999         __________________ Teacher
___ Math 140 (1)                     110150       __________________ Teacher                   ___ *OGT Science (1/2)               132900         __________________ Teacher
___ Social Studies 140 (1)           151210       __________________ Teacher                   ___ Physics (1/2)                    130302         __________________ Teacher
___ Social Studies 140 (1) National Standards     __________________ Teacher                   ___ Forensic Science (1/2)           139999         __________________ Teacher
___ Science 140 (1)                  132120       __________________ Teacher                   ___ Marine Biology (1/2)             139999         __________________ Teacher
5th GRADE
                                                                                               ___ **Aviation (1/2)                 300010         __________________ Teacher
___ Eng/LA 150 (1)                   050154       __________________ Teacher
                                                                                               SOCIAL STUDIES
___ Math 150 (1)                     110150       __________________ Teacher
                                                                                               ___ Geography (1/2)                  150700         __________________ Teacher
___ Social Studies 150 (1)           151210       __________________ Teacher
                                                                                               ___ OGT Social Studies (1/2)         150400         __________________ Teacher
___ Science 150 (1)                  132120       __________________ Teacher
                                                                                               ___ Sociology (1/2)                  151300         __________________ Teacher
6th GRADE
___ Eng/LA 160 (1)                   050154       __________________ Teacher                   LANGUAGE
                                                                                               ___ *Mandarin Chinese I (1)          060102         __________________ Teacher
___ Math 160 (1)                     110150       __________________ Teacher
                                                                                               ___* Mandarin Chinese II (1)         060102         __________________ Teacher
___ Social Studies 160 (1)           151210       __________________ Teacher
                                                                                               ___ French I (1)                     060230         __________________ Teacher
___ Science 160 (1)                  132120       __________________ Teacher
7th GRADE                                                                                      ___ French II (1)                    060230         __________________ Teacher
___ Eng/LA 170 (1)                   050156       __________________ Teacher
                                                                                               ___ French III (1)                   060230         __________________ Teacher
___ Math 170 (1)                     110175       __________________ Teacher
                                                                                               ___ French IV (1)                    060230         __________________ Teacher
___ Social Studies 170 (1)           151201       __________________ Teacher
                                                                                               ___ *German I (1)                    060235         __________________ Teacher
___ Science 170 (1)                  132130       __________________ Teacher
                                                                                               ___ *German II (1)                   060235         __________________ Teacher
8th GRADE
___ Eng/LA 180 (1)                   050156       __________________ Teacher                   ___ Spanish Grade 7 (1/2)            060265         __________________ Teacher
___ Math 180 (1)                     110175       __________________ Teacher                   ___ Spanish Grade 8 (1/2)            060265         __________________ Teacher
___ Social Studies 180 (1)           151201       __________________ Teacher                   ___ Spanish I (1)                    060265         __________________ Teacher
___ Science 180 (1)                  132130       __________________ Teacher                   ___ Spanish II (1)                   060265         __________________ Teacher
9th GRADE
                                                                                               ___ Spanish III (1)                  060265         __________________ Teacher
___ ENG/LA I (1)                     050160       __________________ Teacher
                                                                                               ___ Spanish IV (1)                   060265         __________________ Teacher
___ CP Algebra I (1)                 110301       __________________ Teacher
                                                                                               MATH
___ Integrated Math I (1)            110010       __________________ Teacher
                                                                                               ___ OGT Math (1)                     111950         __________________ Teacher
___ World History (1)                150890       __________________ Teacher
                                                                                               ___ Calculus A (1/2)                 110600         __________________ Teacher
___ Physical Science (1)             132220       __________________ Teacher
                                                                                               ___ Calculus B (1/2)                 110600         __________________ Teacher
___ Integrated Phys. Science (1)     132212       __________________ Teacher
                                                                                               ___ Trans. to College Math (1/2)     111850         __________________ Teacher
10th GRADE
___ ENG/LA II (1)                    050170       __________________ Teacher                   ___ Intervention Math (1)            111950         __________________ Teacher
___ CP Geometry (1)                  111200       __________________ Teacher                   BUSINESS/TECHNOLOGY
                                                                                               ___ Business Math (1/2)              030500         __________________ Teacher
___ Integrated Math II (1)           110020       __________________ Teacher
                                                                                               ___ *Microsoft Word 2003 (1/2)       032800         __________________ Teacher
___ US History (1)                   150810       __________________ Teacher
                                                                                               ___ *Microsoft Word 2007 (1/2)       032800         __________________ Teacher
___ Biology (1)                      132230       __________________ Teacher
                                                                                               ___ *MS PowerPoint 2003 (1/2)        032800         __________________ Teacher
___ Integrated Bio Science (1)       132214       __________________ Teacher
11th GRADE                                                                                     ___*MS PowerPoint 2007 (1/2)         032800         __________________ Teacher
___ ENG/LA III (1)                   050180       __________________ Teacher
                                                                                               ___ *Microsoft Excel 2003 (1/2)      032800        __________________ Teacher
___ CP Algebra II (1)                110302       __________________ Teacher
                                                                                               ___ *Microsoft Excel 2007 (1/2)      032800         __________________ Teacher
___ Integrated Math III (1)          110030       __________________ Teacher
                                                                                               ___ Computer Applications (1/2)      036000         __________________ Teacher
___ Economics (1/2)                  150600       __________________ Teacher
                                                                                               ___ Intro. to the Internet (1/2)     290130         __________________ Teacher
___ Government (1/2)                 150300       __________________ Teacher
                                                                                               HEALTH
___ Environmental Science (1)        132350       __________________ Teacher                   ___ Health (1/2)                     260101         __________________ Teacher
___ Integrated Env. Science (1)      132216       __________________ Teacher                   ___ Physical Education (1/2)         080300         __________________ Teacher
LAB FEES                                                                                       FAMILY AND CONSUMER SCIENCE
*This course requires a $40 lab fee.                                                           ___ Family Living (1/2)              230500         __________________ Teacher
**This course requires a $50 lab fee.
                                                                                               ART
CP – College Prep                       CREDIT (1) = 36 Units (1/2) = 18 units
                                                                                               ___ Art History (1/2)                020101         __________________ Teacher
The EMIS code is provided for districts using Jefferson County ESC faculty members to
teach VLA students. If you are not using Jefferson County ESC faculty members, you may         ___ Renaissance Art (1/2)            029999         __________________ Teacher
choose to assign a different EMIS code.                                                        OTHER
                                                                                               ___ **ACT Prep (1)                   300030         __________________ Teacher
                                                                                               ___ Student Leadership (1/2)         300010         __________________ Teacher