Independent Study Application
Every part of this application must be completed for an Independent Study, otherwise it will be returned to you and you may consequently miss the deadline. If you have questions, you can ask your advisor or stop in to see Nela.

Due date for applications is Thursday October 10th, 2019. Late applications cannot be accepted unless you speak to Nela about an extension BEFORE the deadline.

Before you fill out this application, you must read all of this form and notify the mentor of the information. If the mentor is unaware of his/her responsibilities from the start, they may drop the contract and you may risk receiving an IP.
Student First Name *
Your answer
Student Last Name *
Your answer
Advisor *
Grade *
Student's Email Address *
Please put down the email that you frequently check. This will be how I notify you if you may begin your IS Contract
Your answer
Student Phone Number *
Your answer
Parent/Guardian Contact Information *
Include their name(s), email address(es), and phone number(s)
Your answer
Title of Independent Study *
Your answer
Detailed description of learning experience *
Explain yourself as clear as possible
Your answer
Is this for Path credit? *
Is yes, how is this contract related to your path?
Your answer
Is this for Common Learning credit? *
If yes, what area?
Your answer
Mentor/Teacher Full Name *
Your answer
Has your proposed mentor agreed to the guidelines on the link below? *
Mentor Phone Number *
Your answer
Mentor Email Address *
Your answer
Please describe your mentor’s SPECIFIC qualifications here *
Your answer
Approximately how many credits do you expect to earn? *
.5 credits = 30 hrs. of work
Your answer
During which quarter(s) will this IS be taking place? *
Required
Student electronic signature *
Your answer
Submit
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