2025-2026 ALC IS Summer Referral

2025-2026 IS AREA LEARNING CENTER (ALC) SUMMER SCHOOL REFERRAL & CONTINUAL LEARNING PLAN (CLP)

June 17, 2025 through August 13, 2025, Tuesdays & Wednesdays 8 AM - 12 PM. Technology Village, 11 E Superior St., STE 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.

* If you are a 12th grader who is transferring to ALC to GRADUATE you MUST call the ALC office to notify us.

* If you are currently enrolled and have not completed your Credit Recovery course(s) with ALC, you MUST enroll again for the summer school program with ALC using this form. You will continue where you left off in the course with Credit Recovery (you do not start over).
Student Name: Last
First
Middle
Student Date of Birth

MonthDayYear
Date
Grad Year (GSY)
GRADE
What grade is student going into?
Has student passed their expected graduation date?

YesNo
Male/Female (Choose One)
STUDENT PHONE
Student ISD709 Email
example@isd709.org
Student Personal Email (NOT ISD709 email, NOT parent email, please)
This helps us contact students when their ISD709 email is inactive between enrollments. Please do NOT enter parent email again.
Parent/Guardian Name
Street Address
City
State
Zip code
Home Phone
Parent Cell Phone
Parent Email
example@example.com
Parent Email 2
example@example.com
Federal Ethnicity Codes: please choose number
State Ethnicity Codes: please choose number
Select your School Counselor
Type in counselor email if not in drop down
example@example.com
Case Manager Email (if applicable)
Ex: first.last@isd709.org
Student has a 504 Plan

YesNo
Student receives Special Education Services/has IEP

YesNo
Student qualifies for Families in Transition

YesNo
Please attach supplemental information about required 504 Plan or IEP learning adaptations and/or modifications.
This program is open to youth ages 16 to 20 who meet one or more of the state eligibility guidelines.
Indicators of Need: (Check all that apply)*

Performs substantially below the performance level for pupils of the same age in locally determined achievement testIs a victim of physical or sexual abuse.Has experienced mental health problems.Is at least one year behind in satisfactorily completing coursework or obtaining credits for graduationHas experienced Homelessness sometime within six months before requesting a transfer to an eligible program.Is pregnant or Is a parent.Speaks English as a second language or has limited English proficiency LEPHas been assessed as chemically dependent.Has been excluded or expelled according to sections 121A.40 to 121A.56.Has withdrawn from school or has been chronically truantHas been referred by a school district for enrollment in an eligible program or program pursuant to section 124D.69.Student has met one or more of these criteria.
Goal for current school year*
Student Signature/Agreement I 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 Agreement

Clear
Date

MonthDayYear
Date
Parent or Guardian/Agreement I understand the ALC program requirements. I support the decision of my son/daughter to enroll in the program and expect him/her to work cooperatively with his/her counselor to develop a Continual Learning Plan (CLP) and to put forth full effort to achieve the stated goals.

PARENT SIGNATURE MUST BE PRESENT FOR ENROLLMENT

Furthermore, I consent and agree to:

Duluth Public Schools providing personal identifying information about my child to the software, websites, and web-based applications listed in this document.

Use the district Chromebook in accordance with appropriate behavior expectations as explained here: 2025-26 Blended Learning Form

Understand that any violation of Chromebook Loan Agreement conditions may result in the removal of the Chromebook from the student (if applicable).
Parent or Guardian/Agreement

Clear
Date

MonthDayYear
Date
Parents, please SUBMIT at the bottom of this page. The rest of this form
TO BE COMPLETED BY SCHOOL COUNSELOR/CASE MANAGER/ADMINISTRATION:
English 9III0.51.0
English 10III0.51.0
English 11 (includes Am. Lit.)III0.51.0
Values in Literature0.5
Grammar & Composition0.5
Civics in Global Society0.5
United States HistoryIII0.51.0
World HistoryIII0.51.0
Economics0.5
American Government0.5
Intermediate Algebra IIII0.51.0
Algebra IIIII0.51.0
GeometryIII0.51.0
Probabilities and StatsIII0.51.0
Physical ScienceIII0.51.0
BiologyIII0.51.0
PhysicsIII0.51.0
ChemistryIII0.51.0
Work Experience Seminar0.5
Work Experience Internship (Seminar is a prerequisite)0.51.0
Health0.5
Physical Education0.5
Art0.51.0
Music0.51.0
Empowering Teen Parents0.5
Counselor/Admin. Signature: Necessary for any student who has attended ISD709 classes within the past 12 months.

Note: If applicant is an out of district student, please attach a "referring district" student data sheet with MARSS Number, as well as the Duluth Public Schools Registration Form signed by a parent/guardian or the adult student.
Counselor/Admin. Signature

Clear
Date

MonthDayYear
Date
School
Should be Empty:

2025-2026 IS AREA LEARNING CENTER (ALC) SUMMER SCHOOL REFERRAL & CONTINUAL LEARNING PLAN (CLP)