• SEAT-BASED REFERRAL and CONTINUAL LEARNING PLAN

    2024-2025 Duluth Area Learning Center
  • STOP! Submitting this form will END enrollment at your student's current school. If your intention is to completely transfer to ALC online, please continue and fill out this form.

    If you are looking for CREDIT RECOVERY (making up credit for failed or missing requirements), please contact your home school's counselor to begin that enrollment process.

    PARENTS/GUARDIANS: Please be sure to fill in Section 1 completely and sign before submitting. We cannot process enrollments without signatures.

  • 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 16-20 who meet one or more of the state eligibility guidelines.

    Independent Study is a digital curriculum with Teacher support

    Classrooms will be open Monday-Thursday for full time Independent Study students 8:00am to 5:00 pm or by appointment with teacher.

  • Section 1

    Student/Family Info
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  • Note: if applicant is an out of district student please provide a "referring district" student data sheet with MARSS Number and complete this form for enrollment into the Duluth School District:


    Duluth Public Schools Registration Form 24-25

  • If student has a 504/IEP plan, please submit a copy to ALC by any of the following options:

    • Email
      • kathleen.wilson@isd709.org
      • valarie.wagenbach@isd709.org
    • Fax
      • 218.336.8770
    • Stop into ALC
      • Monday-Thursday
      • 8:00am-5:00pm
  • Annual Health History/Immunizations/OTC Self Medication

  • *** Note for Parent/Guardians  ***

    Prior to the beginning of each school year, emergency care plans and medication authorizations should be turned in to your child's school health office and reviewed with the Licensed School Nurse. 

    All students must comply with Minnesota state statute 121A.15 with regards to immunizations. Exclusion from school will occur if immunizations, medical exemption or objection requirements are not met.

    For your convenience, we have combined forms into one to eliminate the need for you to enter duplicate information multiple times. Please make sure you read through everything so you know what you are signing, parts of these forms may be subject to review by the State of Minnesota. 

    Forms and exemptions must be completed by September 18, 2024.

  • In case of emergency / illness at school and parents can not be reached, call:

  • When prescription medication is to be taken in school: Contact the School Health Office.

    Policy requires that a pharmacy labeled container of the medication be provided, along with written parent/guardian & prescriber permission. Medication forms are available from the school health office. The school is able to fax the provider for permission once parent/guardian signature has been obtained.

  • Parent & student agree to: 

    Student is knowledgeable about the medication and how to administer it.
    Student has the skills to safely possess and use the medication.
    Student may self-administer the medication.
    Student will follow parent/guardian instruction and NOT allow anyone else to use the medication.
    Student will use correct medication administration technique & proper dosing.
    Contact the nurse if student suspects that he/she may be experiencing side effects from medication.
    Medication must be provided by the parent/guardian and must be in a properly labeled container and have manufacturers' recommendations clearly available.

    I understand that permission for self-administration of medication may be suspended if I am unable to follow the procedure outlined.

  • SELF-ADMINISTRATION OF NON-PRESCRIPTION PAIN MEDICATION AUTHORIZATION

    A secondary student (grades 7-12) may possess and use nonprescription pain relief in a manner consistent with the labeling, when the school has received a written authorization from the student's parent or guardian permitting the student to self-administer the medication. The school may revoke a student's privilege to possess and use non-prescription pain relievers if the school determines that the student is abusing the privilege. Students may not possess or use any drug or product containing ephedrine or pseudoephedrine.

    This form must be completed by the parent/guardian/student and returned to the school health office ANNUALLY:

  • I believe that this student is capable of self-administering the following medication: .
    , by mouth, per package instructions. I request self-administration of this medication for the treatment of   .

  • Immunization Information

    Use this chart as a guide to determine which vaccines are required to enroll in child care, early childhood programs, and school (public or private.)

    Find the child's age/grade level and look to see if your child had the number of shots shown by the checkmarks under each vaccine. Children birth to age 2 may not have received all doses. 

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  • *** IMPORTANT ***  Read before you submit.

    ** Parent/Guardian signature here indicates the above information is true in regards to health history, self-administration of non-prescription pain meds, and immunization records, as well as allowing my child’s school to share my child’s immunization documentation with Minnesota’s immunization information system.

    Consent to share immunization information: This school is asking for permission
    to share your child’s immunization record with Minnesota’s immunization informationsystem. Giving your permission will:
    • Provide easier access for you and your school to check immunization records, such as at school entry each year.
    • Support your school in helping to protect students by knowing who may be
    vulnerable to disease based on their immunization record. This can be important
    during a disease outbreak.

    Under Minnesota law, all the information you provide is private and can only be released to those authorized to receive it. Signing this section of the form is optional. If you choose not to sign, it will not affect the health or educational services your child receives.

    Please contact ALC at 218-336-8756 if you cannot sign for all of the above and we will provide a paper copy so you can sign only the portions you agree with.

     
    Please visit ISD709 Health Services for more information (LEFT CLICK to open in a new page so you don't lose your work above!).

    HS-49e (Rev. 4/16) Item #35-15-000885 

  • PERMISSION SLIP FOR EDUCATIONAL FIELD TRIP

    Dear Parent/Guardian:

    During the 2025-2026 school year, students enrolled in the ALC seat-based program may be taking field trips to various places in the Duluth/Superior area. These trips will encourage community building amongst students and staff, as well as be included as enrichment activities for the classroom.

    The Board of Education requires that we have written permission from each parent/guardian for their child to take these field trips. If you are willing to have your child take part in both the educational field trips and fun excursions, please sign this document for our school to keep on file.

    Signing and submitting this form (at the end) gives permission for my student to participate in ALC fieldtrips. 

  • Photo and Video Opt Out Form

    There are many activities and accomplishments that take place in our schools which Duluth Public Schools feel are positive, newsworthy and of interest to the community. Teachers and staff members use photos and videos for the purpose of highlighting student achievements or chronicling classroom and school activities. Those images may be used in informational newsletters, school brochures and marketing materials, social media, school or district websites, by TV stations, or newspapers.

    If, for any reason, you do not want your child’s likeness to be used by Duluth Public Schools or the media, please fill out this form and return it to your child’s school office. A separate form is required for each child.

    This form only applies for the current school year and to classroom activities and
    school events that are not already open to the public.

  • SIGNATURES

  • 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.

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  • I (parent/guardian) 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.  * Signature also includes permission for educational, school sponsored field trips.

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  • Counselor/Admin. Signature is necessary for any student who has attended ISD709 classes within the past 12 months

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