Petition for World Language Credit from a Private School

Pleasanton Unified School District

Petition for World Language Credit From a Private School

This form is to be used each time a PUSD student wishes to receive credit from

___ CACC Chinese School ___ Multicultural Education Research Center

___ Hann-Sing Chinese School ___ Madhu Bhasha Kendra Learning Center

___ Infinity Chinese School ___ Tzu Chi Academy Tri Valley

___ Fremont Chinese School ___SiliconAndhra ManaBadi Telugu School

___ California Tamil Academy

Instructions:

To The Student:

1.  Fill out Part I of this form.

2.  Obtain the signature of the Assistant/Vice Principal for Instruction of your school on Part II.

3.  Give the form to the private school administrator.

4.  Upon completion of instruction, request that the administrator/counselor of your language school complete Part III.

To The Administrator of the Private School:

1.  Conduct instruction (150 hours minimum requirement).

2.  Administer the world language examination.

3.  Complete Part III to verify the language instruction and course completion.

4.  Return this form (with copy of final examination, if available) to administrator of the school the student is currently attending.

Note: Copies to: 1) Principal of private school, 2) student

Part I

APPLICATION FOR CREDIT FOR PRIVATE SCHOOL

WORLD LANGUAGE INSTRUCTION

IMPORTANT NOTE: No high school credit given for classes taken before the summer before 9th grade.

______Birth Date______

Student Last Name First Middle Month/Day/Year

Address:______

I plan to receive instruction in______as taught by

______, while currently enrolled in

(Choose one: CACC, Hann-Sing, Infinity School, Fremont Chinese, California Tamil Academy)

Grade 7 8 9 10 11 12 (circle) at: Amador Valley/Foothill High School

(Choose one)

I have read the instructions noted above and hereby make application for credit equivalent to that given in the school district for the completion of the ______(course title)

Signature:______Date:______

Rev.8/11

Student Name:______Page 2

Part II

ACKNOWLEDGEMENT OF INTENT TO APPLY FOR CREDIT

I acknowledge that the student named in Part I is making an application for credit as indicated above. This student has my approval to follow the course of instruction for credit. Credit will be granted upon successful completion of the course.

Administrator signature:______Date:______

Counselor signature______Date:______

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PART III

VERIFICATION OF WORLD LANGUAGE INSTRUCTION (Private School Administrator)

I certify that the student named in Part I received private school world language instruction as described below while enrolled in the Pleasanton Unified School District.

Language:______Total hours of instruction:______

Dates of instruction:

Beginning:______Ending:______

Examination given:______

(date)

Result:______

Name of Private School:______

Address:______

Signature of Private School Principal:______Date:______

PART IV

CONFIRMATION OF CREDIT

Name of student:______

Number of semester credits given:______for______Semester of ____

Fall/Spring

Signature of Administrator/Counselor:______Date:______