Authorization for High School Credit for Outside Coursework



Quabbin Regional High School

Authorization for High School Credit for Outside Coursework 2016

*Please fill out a separate form for each course a student is looking to take*

This authorization form is to be completed by any student enrolled at QRHS who wishes to earn high school credit for any coursework completed outside of QRHS. This includes college courses, online courses, and/or summer school, and credit make-up programs. This authorization needs to be completely filled out and signed before the beginning of the outside program/course begins to ensure that QRHS will recognize and award the credits upon passing the coursework.

Student Name: ____________________________________________ Grade: _______________

College/Institution/School you will attend (responsible for grading the coursework):

_________________________________________________________________

College/ Institution’s Address: ____________________________________________________________

The course begins on this date: ______________ and ends on this date: _____________

When does the course meet? _____________________________________________________________

Is this Credit Recovery? Yes / No

Do you plan to swap a QRHS course out of your yearly schedule for this course? Yes / No

Please Note:

*The ‘course’ will be entered on the student’s schedule once official registration is produced.

*Students are not allowed to miss classes at QRHS for any outside program, including credit recovery or dual enrollment.

*Please Note that before any credit is awarded a student must have the institution send an official transcript of the grades to Quabbin Regional High School’s Guidance Office.

*Quabbin Regional High School administration retains the authority to determine if a course taken outside of QRHS will count towards a student’s GPA and if so, what level or phase a course will qualify for towards a student’ s GPA, if at all.

*Students are only allowed to take a maximum of 37.5 credits in any school year, this includes courses taken during the summer, except in cases of credit recovery. Courses that are not credit recovery, which are taken in addition to the 37.5 credits a student is scheduled in to during the school year, will not count towards a student’s GPA.

*Transportation is not provided in any capacity.

Student Signature: _______________________________________

Parent Signature: ________________________________________

Date: ______________________

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Administrative Purposes Only:

The above listed course(s) are: ____ Approved ____ Denied

Principal Signature: ____________________________________________ Date: ____________

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Guidance Counselor Signature: ___________________________________ Date: ____________

Guidance Director Signature: ____________________________________ Date: ____________

Updated 6/6/2016

EOE: Quabbin Regional School District’s Policy of nondiscrimination will extend to students, staff, the general public and individuals with whom it does business; and will apply to race, color, national background, religion, sex, disability, economic status, political party, age, handicap, sexual orientation, gender identity, homelessness and other human differences.

PARENTAL CONSENT AND GENERAL RELEASE FOR PARTICIPATION

IN THE QUABBIN REGIONAL HIGH SCHOOL OFF-SITE EDUCATIONAL PROGRAMS (SENIOR INTERNSHIP & DUAL ENROLLMENT)

Students who participate in senior internship and/or dual enrollment, do so off school property and without the direct supervision of school personnel. As such, students who participate in off-site education are exposed to risks similar to those suffered by the working/general population at large, including the risk of automobile accidents while traveling to and from the educational or work site, the risk of work related or general injuries and even the risks posed by criminal elements in the community where the work/educational site is located. By signing this agreement, you recognize the risks attendant in your child’s voluntary participation in this off-site educational program identified below, and you agree that you and your child will not hold the program coordinator, school employees, Quabbin Regional School District, or the Towns that comprise the Quabbin Regional School District legally responsible for any harm that your child may incur as a result of his/her participation in this activity.

Name of Student: ____________________________________ Age of Student: ______

Address of Student: ______________________________________________________

Program Student will be involved in: Senior Internship / Dual Enrollment

Education/Work Site Name and Location: _____________________________________

I am the parent/legal guardian of the above named student, a minor, and on behalf of myself and my minor child, I hereby consent to his/her participation in the above-mentioned voluntary activity, and hereby RELEASE, discharge, and covenant to hold harmless the towns that comprise The Quabbin Regional School District, and The Quabbin Regional School District itself, and their officials, employees, and agents, from any claims or causes of action, known or unknown, which relate directly or indirectly to my child’s participation in this voluntary program, including but not limited to claims arising from all known and unknown personal injuries or property damage that my minor child has or hereafter may acquire, either before or after reaching majority. I acknowledge that I enter into this Agreement knowingly and voluntarily, that I have had an opportunity to consult with an attorney, and that I have a complete understanding of the terms and the conditions of this Agreement.

____________________________ _____________________________

Parent/ Guardian Name (printed) Student Name (printed)

____________________________ _____________________________

Parent/Guardian Signature Student Signature

Date: ___________________

3/2016

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