VIEWPOINT SCHOOL Independent Study Physical Education Application Form School Year 2012-13

Students may petition for off-campus Independent Study to satisfy their PE requirement. Approved activities will consist of those sports in which Viewpoint School participates at the interscholastic level under the guidelines of the California Interscholastic Federation (CIF) with the exception of Golf. Students are also required to participate in that same sport for Viewpoint School during the appropriate season. In order to receive credit for the activity, participants must also meet all application and reporting deadlines as indicated on the application form. All activities must be approved by the Department Chair and require a minimum of six hours of directly supervised physical activity per week. The supervising instructor must be a trained professional, and may not be a family member. Students will be enrolled and required to attend a PE class until the application form is received and approved at the start of the sport season. Mr. Stafford can be reached at 818-591-6266 or gstafford@viewpoint.org. Due Dates for Application Forms: Fall Aug. 27 Winter Nov. 5 Spring Feb. 11 To be approved, the proposed activity must demonstrate a significant commitment to a students physical well being. Activities must be at least 6 hours in duration per week, and supervised by a professional (not a parent) who agrees to report on the students progress monthly. This class will be graded on a Pass/Fail basis only. Name of Student: ___________________________________Grade: ______________ Trimester requested: (please circle) Fall Winter Spring

Proposed activity: __________________________________Hours/week: ________ Name and qualification of supervisor: _______________________Tel.# ___________ For the activity supervisor: I agree to supervise this student in the activity listed above and to provide a monthly report of the students progress to Viewpoint School. Signature: _______________________________ For the parent: I agree to have my child participate in the listed activity to fulfill the requirement of independent study physical education. I understand that, should my child not fulfill the reporting or attendance requirements, the physical education prerequisites to graduation would not have been met. Signature: ___________________________e-mail address: _____________________ For the student: I agree that it is my responsibility to see that Mr. Stafford receives the reporting of this activity by the dates listed below. It is also my responsibility to attend the activity a minimum of 6 hours per week. Signature: ___________________________e-mail address: _____________________ Reporting Dates: Fall Oct. 5, Nov. 2. Winter Nov. 30, Jan. 11, and Feb. 1. Spring Mar. 1, Mar. 22, Apr. 26, and May 31. Approval: _____________________ Mr. Stafford, Chairman, Physical Education

VIEWPOINT SCHOOL Independent Study Physical Education Reporting Form School Year 2012-13
Name of Student: __________________________ Grade: _________Date: _________ Season: Fall Winter Spring

Report for the month of: _____________________________

The student named above has participated in the following activity for the amount of time indicated per week of this month: Activity: ____________________________________ Please list hours per individual week:

Signature of supervisor: ______________________________Tel. #________________ Signature of Student: _________________________________ To the student: It is your responsibility to return a copy of this form to Mr. Stafford, Chair of the Physical Education Department, by the dates listed below. If you do not turn in this form, you will be given a grade of Not Pass in your independent study physical education. A grade of Not Pass may result in failure to satisfy Viewpoint Schools PE requirements. If you have any questions, please contact Mr. Stafford at 818-591-6266 or gstafford@viewpoint.org.

Reporting Dates: Fall Oct. 5, Nov. 2. Winter Nov. 30, Jan. 11, and Feb. 1. Spring Mar. 1, Mar. 22, Apr. 26, and May 31.