Jasper Learning Initiative Commitment Form
The 19-20 Jasper pilot can accommodate up to 125 students in the program.  Commitments will be accepted first come, first serve for the first 100.  If/when the number of commitments exceed 100, there will be a lottery system for participation in the program for the last 25 spots.
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Student Name *
Parent/Guardian Name *
Address *
Parent/Guardian Email *
Parent/Guardian Cell Phone or Home Number *
Date of Birth *
MM
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DD
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YYYY
Present Middle School *
Do you have an IEP or 504? *
Required
What math course are you enrolled in now? *
Why do you want to enroll in the Jasper Learning Initiative?   *
Describe some of your interests. *
What is important for you to learn at school? *
What are some goals you have set? *
Describe an exciting learning experience you had recently (in school or outside school) *
In what types of situations do you learn best? *
What skills, talents, or qualities do you possess that would make a positive contribution to the Jasper Learning Initiative community of teachers and students? *
We, the undersigned, have explored the philosophy, core values, and structure of the Jasper Learning Initiative and wish to enroll.  We understand if the program does not prove to be the appropriate educational structure, the staff or advising team may decide the student must exit the program and resume the traditional schedule at Emmaus High School.  We, as parents, understand that once our child is enrolled we will meet minimum expectations of involvement with the Advising Team as needed.  Our signatures indicate permission for our child to enroll in the Jasper Learning Initiative to attain his/her educational goals.   (Student electronic signature below) *
(Parent electronic signature below) *
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