2024-2025 Credit Recovery Referral

CREDIT RECOVERY REFERRAL and CONTINUAL LEARNING PLAN

2024-2025 Duluth Area Learning Center
PARENTS/GUARDIANS: Please be sure to fill in Section 1 completely, sign section 3, and continue on to the Continual Learning Plan section.
Technology Village: 11 E Superior St, Suite 450, Duluth, MN 55802

Phone: (218) 336-8756 FAX: (218) 336-8770

This program is open to youth ages 16 to 20 who meet one or more of the state eligibility guidelines.

Credit recovery is a digital curriculum with Teacher support.

Classrooms will be open Monday-Thursday for Credit recovery students 1:00 - 5:00PM
Section 1

Student/Family Info
Student Name

First NameMiddle InitialLast Name
Student Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Grad Year (GSY)
Current Grade
STUDENT PERSONAL EMAIL (NOT isd709 email)
example@example.com
STUDENT PHONE NUMBER
Include area codeFormat: (000) 000-0000.
Parent/Guardian Name #1
Full Name
Parent/Guardian #1 email
example@example.com
Parent/Guardian #1 Cell number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Name #2
Full Name
Parent/Guardian #2 email
example@example.com
Parent/Guardian #2 Cell number
Please enter a valid phone number.Format: (000) 000-0000.
Note: if applicant is an out of district student please provide a "referring district" student data sheet with MARSS Number.
Does student have a 504 plan?
Does student receive Special Education Services?
If student has a 504/IEP plan, please submit a copy to ALC by any of the following options:
- Email
  - valarie.wagenbach@isd709.org
  - kathleen.wilson@isd709.org
- Fax
  - 218.336.8770
- Stop into ALC
  - Monday-Thursday
  - 8:00am-5:00pm
Does student qualify for Students in Transition?
Please select your student's counselor
Case Manager Email
example@example.com
I (student) understand the ALC program requirements. I will work cooperatively with my counselor to develop a Continual Learning Plan (CLP) and promise to put forth full effort to achieve my stated goals.
Student Signature/Agreement
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
ENROLLMENT WILL NOT BE COMPLETED WITHOUT PARENT/GUARDIAN SIGNATURE.

I understand the ALC program requirements. I support the decision of my son/daughter to enroll in the program and expect them to work cooperatively with their counselor to develop a Continual Learning Plan (CLP) and to put forth full effort to achieve the stated goals.

Please sign, date, and scroll down to submit form. You will receive an email confirmation.
Parent or Guardian/Agreement
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian, please submit at bottom of the page.
** REQUIRED ** All students must meet MN state requirements for enrollment in ALC. Please check all that apply
Please select Class(es), Semester (A or B) and Credit amount (0.5 or 1.0)
** REQUIRED ** Educational Goals for the current school year
Courses student is enrolling in
Current School
Counselor/Admin/Case Worker Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Counselor/Admin. Signature is necessary for any student who has attended ISD709 classes within the past 12 months.
Should be Empty:

CREDIT RECOVERY REFERRAL and CONTINUAL LEARNING PLAN

Section 1

Parent/Guardian, please submit at bottom of the page.