Miami-Dade Virtual School Course Request Form Student Information Student's Legal Barros, Stephanie Name: Virtual

School 1095765 Student Number: Student Email Address: Parent/Guardian Email Address: Parent/Guardian Work Phone: Unweighted GPA: 0.1000 IEP: False Student's Base North Miami Senior High School School: School State: FL

Grade Level: Date of Birth: Phone:

12 9/27/1992 (305) 244-6181

Parent/Guardian Cell Phone: Weighted GPA: 0.1000 School District: District Student ID: Miami-Dade 6487640

Courses Requiring Verification Course Biology I Course Code 2000310 Part 2 Preferred Start Requested Date Date November 11/28/2010 2010 Status Virtual School FLVS

Previously Verified Current Courses Course Course Code Segment Preferred Start Requested Date Date

SCHOOL COUNSELOR SECTION Please verify that all student information provided on this form is accurate. All M-DVS courses must be taken for credit. The student will only be considered for admittance to the course(s) specifically identified by the school counselor. The student must also meet the M-DVS pre-requisites and adhere to M-DCPS student progression plan. I have reviewed the student information provided on this form and confirm that we are the official school of record for this student. I have reviewed and confirm that the course(s) the student has requested is an appropriate placement based on the student s academic history and needs. As stipulated by the Florida K-20 Education Code (s.1002.20), parents have the right to choose educational options such as Miami-Dade Virtual School for their children. A student s full-time school may not deny access to courses offered by MDVS assuming that the desired online course(s) is an appropriate course placement based on the student s academic history, grade level, and age. Students will bring this signed Course Request Form (CRF) to their School-Based Guidance Counselor. Upon receipt of the CRF, Guidance Counselors will log in to their M-DVS online account with their username/password. Guidance Counselors will use the same username and password as their FLVS account. Guidance Counselors without a username/password, should contact the school principal for account information, which has been mailed to the Principal of each school. Once logged into their MDVS Online Account, Counselors will be able to approve student course request(s). Please approve only those requests that are appropriate based on the student s academic history, grade level, and age.

Please note, if the counselor is handed a CRF with a Guardian signature, the Counselor can check both Guidance and Guardian approval for the student s course request(s). Course requests that are not approved will be removed by MDVS after a period of time. COURSE PLACEMENT SECTION ***Important Information*** This course request does NOT guarantee placement. Enrollment in an M-DVS course is dependent upon space availability. All students will be placed on a wait list until they are assigned to course(s) based on the M-DVS student enrollment policies, M-DVS pre-requisites, MDCPS pupil progression plan, and appropriate academic placements. Your preferred start date will not affect placement into the course. As we cannot predict the volume of requests that will come in, we will continue to place students into courses throughout the school year as seats become available. This means that you may be placed AFTER your preferred start date. As always, M-DVS will make every attempt to accommodate your requests. If you are placed in your desired course(s), you will receive an email informing you of the name of your teacher. PARENT SECTION As the parent or legal guardian of the student above, I understand that it is impossible for M-DVS to monitor student access to controversial material while using the Internet and that I accept responsibility if and when my child s Internet use is not in a school setting. The student also understands that if he/she violates M-DVS policies and/or the Code of Student Conduct at his/her fulltime school, his/her enrollment may be terminated and he/she may face other disciplinary measures. Please sign below to attest that you have read and agree to the M-DVS Student Contact and Drop Policy, the Student Code of Conduct/Acceptable Use Policy, and the Academic Integrity Policy. I give permission for my child to request the M-DVS courses that are listed above. My signature also acknowledges my permission for MDVS to access my student s records and test scores from various educational institutions as needed. In order to approve the desired course requests, parents/guardians are encouraged to create an online Guardian account which allows access to approve course requests online. Parents/Guardians can create accounts by going to our home page and clicking on Apply for Guardian Account. Parent Signature and Date: X__________________________________________________________ Student Name (printed): X____________________________________________________________ Student Name (signature) and Date: X___________________________________________________

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