Course Request Application

101 W. 29th Street Anderson, IN 46016 P: (765) 649-8472

Staff Elementary PreAcademy Academy

Anderson Preparatory

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Course Request Application

Today's Date:

Cadet Name:

Grade Level

Name of Requested Course:

Which part of the school year is this request for?

Term - 1
Term - 2
Summer - Term

Teacher recommendation: Please name the teacher who will recommend and verify that you would be a strong candidate for this course. (Note: Teacher recommendation must be from a teacher in the subject area of the course you're requesting to take, and this recommendation will be verified by the Counselor or Director of Academic Programs. )

Because of the rigor and independent work ethic required to take on a course independently, the following criteria must be met. By checking each box, you are agreeing that you will follow these guidelines.

No previously failed courses
Cadet must adhere to assigned due dates and timelines
Course must be initiated at the beginning of a semester and finished by the end of the semester
If course is not completed by the stated deadline, cadet will receive an “F” grade on transcript
Final exams must be arranged to be taken with the Mentor Teacher/Proctor
Cadet must request withdraw within two weeks from the beginning of the semester
ONCE PER WEEK, you must check in with your Mentor Teacher/Proctor.
Summer courses must be completed by the beginning of the next school year.

In detail, please describe why you are qualified to take this independent study course and what strategies are you going to use to be successful in this course?

By typing your name in the box below you are agreeing to the above listed criteria and expectations set forth for this independent course. Please sign by typing your first and last name:

To validate your submission, please answer the following math problem: