In an era where digital advancements have increasingly influenced the educational landscape, the Ed 02400 04 form serves as a crucial conduit for students navigating online learning opportunities. Positioned by the Center for Postsecondary Success, this form acts as a supplemental notice of student registration, facilitating the enrollment of students in online courses offered by certified public school providers outside their regular school day schedule. Essential for those seeking enrichment, credit recovery, or resolutions to schedule conflicts, it necessitates detailed input from students, guardians, and educational representatives alike. It meticulously outlines the expectations and responsibilities of all parties involved, ensuring that each student's venture into online learning is underpinned by a clear framework of support and understanding. The form is segmented into comprehensive sections, each demanding attention to the specifics of the online learning engagement - from the identification and rationale behind opting for an online course to the detailed program plan that enumerates the course specifics, including the critical funding and credit acceptance considerations by the enrolling district. Through this procedural document, a foundation is laid not only for students to access alternative learning opportunities but also for educational institutions to seamlessly integrate these outside resources into their conventional academic offerings, signaling a collaborative effort towards a more adaptable and inclusive educational system.
| Question | Answer |
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| Form Name | Form Ed 02400 04 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | mn online learning supplement department of labor mn separation notice form |
Center for Postsecondary Success
1500 Highway 36 West
Roseville, MN
O n l i n e L e a r n i n g ( O L L ) S u p p l e m e n t a l
N o t i c e o f S t u d e n t R e g i s t r a t i o n
GENERAL INSTRUCTIONS: The online learning supplemental notice of student registration is used to register for a supplemental online learning course from a certified public school online learning provider. Supplemental online learning means an online course taken in place of a course period during the regular school day at a local district
SUBMIT the completed form to the online learning provider listed in section II. One form per student per term is required.
Section I: To be completed by the parents and student after they have had initial meetings with the enrolling district and online learning provider. Please sign only after you have reviewed the online course and program and understand the expectations of enrolling in online learning.
Section II: To be completed by the online learning provider and enrolling district online contact person. Each school should keep a copy of this form when all signatures have been secured. The enrolling district has 15 days to review the attached course syllabus and sign and submit the form to the online learning provider.
SECTION I: IDENTIFICATION INFORMATION
TO BE COMPLETED BY THE STUDENT AND PARENT OR GUARDIAN
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Student Name (Last, First, M.I.): |
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Date of Birth: |
Gender: |
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Student’s |
Student’s home phone: |
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Student’s cell phone: |
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Address: |
City, State Zip code: |
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Current Grade Level: |
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Enrolling School: |
Student MARSS Number: |
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Last Grade Completed: |
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Mother/Guardian Name (Last, First, M.I.): |
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Home phone: |
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Mother’s work phone: |
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Mother/Guardian Address: |
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City, State, Zip Code: |
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Mother/Guardian’s
Mother’s cell phone
Father/Guardian Name (Last, First, M.I.)
Home phone: Father’s work phone:
Father/Guardian Address:
City, State, Zip Code:
Father/Guardian’s
Father’s cell phone
Student reason for enrolling in online learning:
Course not offered at school Schedule conflict
Enrichment / Advanced learning opportunity Credit recovery
If so, is the course(s) being taken in addition to a
Yes No
Other (please provide reason below)
Please indicate what type(s) of internet connection you will be using to access your courses:
Cable/DSL
High Speed Home Connection
High Speed School Connection
No internet access – I plan to participate in this course at:
I have discussed enrollment in online learning with my enrolling school representative and the online learning program representative. I have reviewed the online course(s)and program listed on page 2 and understand the expectations of enrolling in online learning
Student Signature: |
Date: |
(required) |
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Parent Signature: |
Print name and relationship: |
(required for students under 18 years old) |
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Center for Postsecondary Success |
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O n l i n e L e a r n i n g ( O L L ) S u p p l e m e n t a l |
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1500 Highway 36 West |
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N o t i c e o f S t u d e n t R e g i s t r a t i o n |
Roseville, MN |
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SECTION II: OLL PROGRAM PLAN |
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TO BE COMPLETED BY OLL PROGRAM PROVIDER AND ENROLLING SCHOOL CONTACT PERSON |
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Page 2
Online Learning (OLL) Program: |
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Telephone: |
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Fax: |
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Online Learning Program Coordinator: |
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Online Learning Program Mailing Address: |
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City, State, Zip Code: |
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Enrolling School: |
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District Number: |
Telephone: |
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Fax: |
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Enrolling School Contact Person or Counselor: |
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Enrolling School Mailing Address: |
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City, State, Zip Code: |
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OLL proposed plan for __ |
_________________________________________________Student MARSS #___ |
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(student name)
OLL Courses
(courses may not exceed 50% of student’s full schedule)
Credit Recovery
Start Date
Sem/Tri/Qtr.
Credits
Proposed completion date
*Meets enrolling district’s graduation requirements. Please check & initial
To be completed by the enrolling district:
Check one of the following:
This coursework will substitute for other course work in the enrolling district and will be funded by the normal funding formula for online learning.
This coursework will substitute for other course work in the enrolling district and will be funded by a contractual agreement with the enrolling district.
This coursework is being taken in addition to the regular district course work and the tuition will be paid by the student. I am a private or homeschool student and will pay tuition for which I will be billed
Check one of the following:
Accepts credits based on MN Statue 124D.095
Enrolling district waives 50% online learning credit limit
A separate agreement has been made for exceeding 50% registration limit between the OLL provider and the enrolling district.
Check one of the following: |
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The student has notified the enrolling district before the midpoint of the current term. |
Midpoint Date: |
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The student has NOT notified the enrolling district before the midpoint of the current term, but we have elected to waive this requirement. |
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The student has NOT notified our district before the midpoint of the current term, and the student is responsible for the paying of tuition |
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Check if it applies: |
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The student has an active IEP on file If checked please provide the following information: |
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Special Education Case Manager Name: |
Phone |
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The student is receiving ELL services |
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I have shared the online learning course(s) syllabus with the enrolling district contact person.
Signature of OLL provider contact person
Print name and title |
Date (please submit to enrolling district contact person) |
I have reviewed the course syllabus and the course(s) checked meet the enrolling district’s graduation requirements.
Signature of enrolling district online learning contact person
Print name and titleDate notification receivedDate signed and returned to OLL Provider
Schedule changes may not be made after the midpoint of enrolling district’s term unless waived by both schools.
ATTN: Upon completion submit this form to the online learning provider in section II.