Copy of PLE Application Revised 17-18
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PERSONALIZED LEARNING EXPERIENCE (PLE)
APPLICATION
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Please complete both pages of this form with the PLE Coordinator and Faculty Sponsor. The PLE Coordinator is available to assist the student in developing the PLE Learning Targets. All information must be complete before beginning PLE in order to earn credit.
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Student Name:Date:
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Faculty Sponsor:Student ID Number:
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Timeframe:
During Period:
Grade Level:
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PLE Title:Requested Credit:
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Subject Area/
Department:
Grading Method:
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Student should obtain the first four signatures & return completed form to the PLE Coordinator.
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Student:
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Parent:
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Faculty Sponsor:
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School Counselor:
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PLE Coordinator:
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Principal:
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Routing:PLE
Coordinator
PowerSchool ManagerSchool CounselorPLE
Coordinator
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Please initial & date
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form completed & recordedsection created & schedule revisedPLE reflects graduation planrecords
management
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PERSONALIZED LEARNING EXPERIENCE (PLE)
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LEARNING TARGETS
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PLE Description/Summary:
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Describe expected outcome(s)/standards-based learning objectives of this PLE:
(attach applicable standards- CCSS and/or content specific)
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Criteria for successful completion of the PLE, including assessments:
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Anticipated hours for successful completion:
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Reason for selecting this PLE:
Explain why you are pursuing a PLE and what you hope to learn from the experience.
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Document the components of the PLE and the learning environment/location where the PLE will take place:
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Other information to be considered:
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