Application/student-Parent Agreement Template printable pdf download

School Board of St. Lucie County

Performance-Based Diploma Program

Application/Student-Parent Agreement

(Please Print)

Name: ____________________________________________ Student ID #: _____________________________

Date of Birth: _________ Age: _____ Home Phone #: _______________ Cell Phone #___________________

Student Address: __________________________________________________ City: _____________________

Zip: ____________ E-Mail: ____________________________________________________________________

Mother’s Name: ___________________________________________ Work Phone #: _____________________

Father’s Name: ____________________________________________ Work Phone #: _____________________

Guardian’s Name: __________________________________________ Work Phone #: _____________________

Guardian: Please bring “proof” of guardianship.

The Performance-Based Diploma Program has been explained to me, and I believe it will best meet my

educational needs and interests. I understand that if I am enrolled in this program I will have to:

1. Attend school daily; except for excused absences.

2. Pass the Reading and Math Sections of the Florida Comprehensive Assessment Test.

3. Specialize in a vocational education area (3 – 7 credits).

4. Complete the required credits to graduate.

5. Earn a minimum cumulative GPA of 2.0.

I agree to cooperate with the teachers and the school if I am considered for enrollment in this program. I

understand that my attendance, performance, and behavior will determine whether I remain in the Program.

This is a voluntary program. As parents, you have the right to an administrative review of any action relating to

this placement. You also have the right to request an evaluation of your student for Exceptional Student

Education.

___________________________________________

__________________________________________

Student Signature

Parent Signature

Vocational Program:

You will select a Vocational Program to be completed as part of your electives. This is required to graduate.

Program: ____________________________________

Number of Credits: __________________________

Based upon the review of the student profile I recommend:

•

Approval of enrollment into the Performance-Based Diploma Program

•

Disapproval of enrollment into the Performance-Based Diploma Program

_________________________________________________________

________________________________

Signature (Program Specialist)

Date

White:

Canary:

FPC0004 Rev. 10/09

Application/student-Parent Agreement Template