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Email *
District
School Year *
Student Name *
Grade Level *
Additional Student Name
Grade Level
Additional Student Name
Grade Level
Additional Student Name
Grade Level
Additional Student Name
Grade Level
Primary Parent/Teacher Name *
Email Address *
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Does your attendance record show at least 90 days? *
Did the curriculum include, but was not limited to, the basic instructional areas of reading, writing, mathematics, science, and social studies, and in grades seven through twelve, composition and literature? Have you written a brief progress report for each student in each subject and filed it in your records? *
Did you follow the regulations that state educational records shall be maintained by the parent-teacher and include:  (1) a plan book, diary, or other record indicating subjects taught and activities in which the student and parent-teacher engage;  (2) a portfolio of samples of the student’s academic work; and  (3) a semiannual progress report including attendance records and individualized documentation of the student’s academic progress in each of the basic instructional areas specified in item (c) above? *
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