eLearning Request Form and Contract
Students/Parents/Guardians please fill out the requested information then read the items and check the statements under the eLearning Student/Parent/Guardian Contract. Please understand submission of this form does not guarantee an eLearning course as there are limited spaces available.
Email *
Student First Name *
Student Last Name *
Student ID # *
Grade Level *
Date of Birth *
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/
DD
/
YYYY
Student's DPS Email Address *
Student Phone Number *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Academic Term you are requesting the eLearning course? *
Course you are requesting: *
Please briefly explain the reason you are requesting this eLearning opportunity. *
Do you have a 504 or IEP Plan? *
eLearning Student-Parent/Guardian Contract
Student and Parent/Guardian will need to read each statement below and check the box confirming your understanding of each statement. Checking each box will constitute signatures of both student and parent.
Student will attend classes and fully participate in the enrolled course(s) as required by the eLearning course AND Jordan High School. (Students will receive assignments via the internet and will be required to complete them according to the eLearning teacher's time schedule. Students will work independently.} *
Required
I understand that if I do not log into my eLearning course(s) within the first 7 days, I will be automatically dropped from the course. *
Required
The minimum time requirements for and eLearning courses are as follows:.....Fall and Spring courses (90 Minutes of work each day Mon-Friday).....Yearlong courses (50-60 minutes of work each day Mon-Fri)....Summer School (3-5 hours of work each day Mon-Fri)...Time commitments can depend on the course. *
Required
Students must have daily access to the internet. *
Required
The eLearning Provider's calendar might not match Durham Public Schools' calendar. I understand that I will submit assignments as required by the eLearning Provider calendar. *
Once enrolled in an eLearning course the student must stay enrolled for the duration of the course. *
Required
eLearning courses taken for FTC (First Time Credit) will be included in the students GPA (Grade Point Average) *
Required
Students will exhibit appropriate etiquette while communicating with peers and the eLearning instructor, *
Required
Students will inform  eLearning instructor and on site facilitator in a timely manner if they are experiencing difficulties in the course (e.g. technical difficulties, navigational difficulties, or comprehension difficulties). *
Required
Student will inform eLearning instructor or on site facilitator of any scheduled or unscheduled absences and make up missed work as required. *
Required
Student will use the school network and equipment in compliance with the Durham Public Schools Acceptable Use Policy. *
Required
For eLearning approved course that require an EOC or CTE State assessment, student will agree to the testing schedule that Jordan High School provides me. *
Required
If any equipment (technology) or textbooks are checked out for a particular eLearning course, the student agrees to return the checked out items at a designated location after the final exam for the course as indicated by school communication. *
Required
*I affirm that the student will complete assignments, projects, and tests without the assistance of another person or resource, unless permitted by the eLearning instructor. I further affirm that all work will be done by the student's own origin and the student will cite resources when required. I have read this and the above statements. I understand and agree to abide by this contract.* *
Required
A copy of your responses will be emailed to the address you provided.
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