OFF-CAMPUS PHYSICAL EDUCATION
PROGRAM PROCEDURES
1. The student receives an Off-Campus Physical Education packet from the off-campus coordinator or school counselor
2. The student and parent(s) read all information in the packet and fill out the appropriate portion of the application form.
3. The student and agency instructor fill out and sign the appropriate portion of the application form.
4. The application form and payment must be turned in to the off-campus coordinator at least two weeks prior to the beginning of the semester for which they are applying.
5. After checking the application thoroughly, the off-campus coordinator will sign the form and notify the counselor of acceptance into the program. If there are any concerns, the counselor will notify the parent(s).
6. The off-campus coordinator will monitor the agency during the semester to stay in compliance with the TEA regulations.
7. Grades will be given by the agency instructor to the off-campus coordinator, who is responsible for the grade reporting.
8. Any changes in schedule must be reported immediately to the off-campus coordinator. Off-campus PE students and agency instructors will be visited twice within the semester.
9. A fee of $75 per semester will be paid to the Allen Independent School District. Checks should be made payable to Allen Independent School District.
10. Off-campus programs must be located within twenty-five miles of the Allen Independent School District.
11. We do not offer off campus PE for sports that are offered as part of the school curriculum.
***Payment should be submitted with the application.
ALLEN INDEPENDENT SCHOOL DISTRICT
OFF-CAMPUS PHYSICAL EDUCATION APPLICATION
TO BE COMPLETED BY STUDENT: This information pertains to the year of participation.
NAME ______SCHOOL ______
SCHOOL YEAR ______SEX: M_____ F _____ GRADE ______
PARENT/GUARDIAN ______COUNSELOR ______
ADDRESS ______ACTIVITY ______
CITY ______ZIP ______HOME PHONE ______
NAME OF AGENCY OR FACILITY ______
ADDRESS ______CITY ______ZIP ______
TELEPHONE ______INSTRUCTOR (PLEASE PRINT) ______
1. I am applying for admission into off-campus physical education for the:
FALL SEMESTER ______SPRING SEMESTER ______BOTH SEMESTERS ______
2. If accepted into the off-campus physical education program, I would like the following arrangement used in scheduling
the time for off-campus physical education. (Check only one) These options are subject to the approval of the student’s principal.
LATE ARRIVAL ______EARLY DISMISSAL ______NEITHER ______
STUDENT SIGNATURE: ______
TO BE COMPLETED BY SCHOOL OFFICIALS:
The student is taking this course for physical education credit and he/she will not be enrolled in another physical education class or athletics while participating in the Off-Campus Physical Education Program. The student may not transfer from athletics or another Physical Education class into Off-Campus Physical Education after the start of the semester.
COUNSELOR ______DATE ______
PRINCIPAL ______DATE ______
TO BE COMPLETED BY PARENT AND STUDENT:
I have carefully read the guidelines for the Off-Campus Physical Education Program, and I agree to comply with those regulations. I hereby release the Allen Independent School District, its employees, agents, and its Board of Trustees, from all claims or liability in any way attributable to this program, including all travel to, and from, and during the program. I also understand that all liability in case of accident or hospitalization is the responsibility of the parent or of the private or commercial school. The Allen Independent School District is not responsible for accident or hospitalization insurance. I understand that the Allen Independent School District is not responsible for the daily activities of the program, quality of the program, or qualification of the instructor in the program.
My son/daughter, ______has permission to participate in the Off-Campus
Physical Education program for ______at ______
(Off-Campus Sport) (Off-Campus Agency)
Parent/Guardian Signature ______Date ______
If you have any questions completing this application form, please contact the Off-Campus PE Coordinator, or the Counselor’s office.
OFF-CAMPUS PHYSICAL EDUCATION
AGENCY/INSTRUCTOR AGREEMENT
Agency: ______Instructor: ______
Address: ______Telephone: ______
______Zip Code: ______
As a professional instructor, I am aware of the emphasis on program objectives, grading based on performance and attendance established by public education and the Allen Independent School District. I understand the problems inherent in a program such as Off-Campus Physical Education and the importance of maintaining program integrity. Therefore, I will support the following conditions to my certification as an Off-Campus Physical Education instructor.
1. The instructor will adhere to the district’s guidelines for attendance by the student.
♦ The student must participate in his/her activity, under professional supervision,
a minimum of fifteen (15) hours each week at one agency.
♦ The required fifteen (15) hours each week must be spread over at least four days
and include at least ninety minutes of instruction by one approved instructor.
♦ At least ten (10) of the required hours each week must be completed Monday
through Friday.
♦ A maximum of two of the ten required hours each week may be accounted for in
competitive meets/tournaments.
2. The instructor will keep an accurate record of student attendance.
3. The instructor will forward a grade recommendation based on student performance and
attendance as requested.
4. The instructor will submit a written outline of program objectives and activities when
requested.
5. The instructor will contact the Off-Campus Physical Education Staff if a student’s
attendance becomes irregular.
I understand that the Allen Independent School District is accountable for the participation of each student in Off-Campus Physical Education. I will make every effort to cooperate with the district in their accounting procedures.
______
Instructor’s Signature Date
Please answer the questions on the next page. Please be specific. This is a vital part of the approved process for your program.
1. Generally describe your program.
2. In what daily activities will the student be involved?
3. Please list qualifications of the instructors for this program.
4. As the qualified professional instructor, are you willing to strongly recommend that this
student possesses “Olympic level participation”?
TO BE COMPLETED BY THE AGENCY INSTRUCTOR:
The student must participate in his/her activity, under professional supervision, a minimum of fifteen hours each week at an approved agency. The majority of the required fifteen hours each week must be acquired Monday-Friday by one approved instructor. A maximum of four hours each week may be accounted for in competitive meets/
tournaments.
TENTATIVE SCHEDULE:
Indicate the beginning time, ending time, and the nature of the activity. It is imperative that this schedule be kept current at all times. In case of a change in schedule, please notify the Off-Campus Physical Education Coordinator.
BEGINNING TIME ENDING TIME ACTIVITY
MONDAY ______
TUESDAY ______
WEDNESDAY ______
THURSDAY ______
FRIDAY ______
SATURDAY ______
SUNDAY ______
______
Signature of Agency Instructor Date
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