REQUEST FOR PERSONAL CURRICULUM. Student with IEP
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1 REQUEST FOR PERSONAL CURRICULUM Student with IEP In April 2006, Public Acts 123 & 124 were passed and beginning with the class of 2011, they specified 16 credits which are a minimum required to graduate from a Michigan public high school. For the class of 2016, two credits of a language other than English are added for a minimum of 18 credits. Public Act 141 allows to these credits through a personal curriculum. Al high school diploma may be awarded to a pupil who successfully completed his or her personal curriculum even if it does not meet the requirements of the Michigan Merit Standard. 1. Student Information Name: Birthdate: Counselor: Requested By: Parent/Legal Guardian Student (age 18 or an emancipated Anticipated Graduation Date: minor) Teacher Name of : Home Phone: School: Graduating Class: 2. The personal curriculum is being requested for: A student with a current IEP whose disability (ies) necessitate(s) modification of one or more Michigan Merit credit requirements. The requested modification(s) must be consistent with both the pupil s educational development plan (EDP) and his/her individualized education program (IEP): EDP Career Area: IEP Subject Area(s) impacted by disability: 3. Credit Modifications Requested-aligned to area selected above in Section 2, check all curriculum areas of requested English Language Arts Mathematics Physical Education & Health Language other than English Social Studies Science Online Learning Experience Visual, Performing, or Applied Arts 4. Signature of Person Requesting Personal Curriculum Requested by: Date: Office use: Received by: Meeting date: Parent notification date: by:
2 PERSONAL CURRICULUM PLAN Student with an IEP Date: 5. Personal Curriculum Meeting Participants (Signature indicates attendance) Student Counselor/Designee Teacher in area of concern 6. Evaluation Information (Education Development Plan, IEP & teacher input is required for all students with IEPs requesting a Personal Curriculum. Check other information this is available and that applies.) Education Development Plan (EDP) career goals or pathway, educational training goals, plan of action Current Individual Education Plan (IEP) Date: Curriculum Impact area(s): MEAP / MME / ACT Plan / ACT EXPLORE Teacher Input 7. Eligibility for a Personal Curriculum Does NOT Meet Requirements Reason? (Proceed to SECTION #12) Meets Requirement(s) (if all of the statements below are true): A student with a current IEP who needs to modify any of the credit requirements. The modification, which is necessary because of the pupil s disability, is to be consistent with both the pupil s educational development plan and their individualized education program (IEP). The student s disability necessitates modification of 1 or more Michigan Merit Curriculum requirements. The requested modification is consistent with EDP. The requested modification is consistent with IEP. 8. Check individual credits eligible to be modified based on section 7 English Language Arts 4 credits Mathematics 4 Credits Grade 9 Grade 11 Algebra 1 Geometry Grade 10 Grade 12 Algebra 2 Math or Math Related Credit Science 3 credits Biology Chemistry or Physics Social Studies 3 credits World History/Geography Economics Additional Science: US History/Geography Civics Physical Education & Health 1 credit Language other than English 2 credits PE Health Online Learning Experience Visual, Performing, or Applied Arts 1 credit
3 Section 9: Specify how each individual credit identified in Section 8 will be modified. Fill in only those identified; cross out those not used. For student with current IEPs, must look to EDP and IEP impact areas, and cannot exceed decision rules for reducing # of HSCEs to be mastered or level of proficiency to indicate mastery. If credit substitutions are made, the substitution should yield the required number of credits in the core curriculum area. ELA Required Credits Check requested Personal Curriculum credit changes & specify Grade 9 Grade 10 Grade 11 Grade 12 ELA Comments: Mathematics Required Credits Check requested Personal Curriculum credit changes & specify (a student must successfully complete at least 1 mathematics course during his or her final year of high school.) Algebra 1 Geometry Algebra 2 Additional Math Credit Math Comments: Science Required Credits Check requested Personal Curriculum credit changes & specify Biology Chemistry or Physics Additional Science Credit ELA Comments: Social Studies Required Credits Check areas of requested Personal Curriculum & specify Civics (0.5 credits) Economics (0.5 credits) World History & US History & Geography Geography Social Studies Comments:
4 Section 9: Specify how each individual credit identified in Section 8 will be modified. Fill in only those identified; cross out those not used. For student with current IEPs, must look to EDP and IEP impact areas, and cannot exceed decision rules for reducing # of HSCEs to be mastered or level of proficiency to indicate mastery. If credit substitutions are made, the substitution should yield the required # of credits in the core curriculum area. Health & Physical Education Required Credit Check areas of requested Personal Curriculum & specify Health Physical Education Health & Physical Education Comments: Visual, Performing & Applied Arts Required Credit Check areas of requested Personal Curriculum & specify Visual, Performing & Applied Arts Visual, Performing & Applied Arts Comments: Online Requirement Check areas of requested Personal Curriculum & specify Online Requirement (Can be fulfilled by an online course, learning experience or incorporated into required MMC credits) Online Additional Comments: Language other than English Required Credit Check areas of requested Personal Curriculum & specify World Language World Language Comments:
5 10. Quarterly Academic Updates Public Law 623 Section 5(d) states: The pupil s parent or legal guardian shall be in communication with each of the pupil s teachers at least once each calendar quarter to monitor the pupil s progress towards the goals contained in the pupil s personal curriculum. 11. Personal Curriculum Revisions Public Law 623 Section 5(e) states: Revision may be made in the personal curriculum if the revision are developed and agreed to in the same manner as the original personal curriculum. 12. Signatures in Agreement The credit in this personal curriculum have incorporated as much of the subject area content expectations as is practicable for the pupil. When approved and enacted, the specified coursework and its curriculum become the measureable goals, which will be monitored through progress reports and report cards. This personal curriculum was aligned with the student s Education Development Plan and IEP. Student High School Counselor/Designee Special Education Teacher 13. District Commitment I approve this personal curriculum request. Actual implementation date (Month/Day/Year) OR the first day of the school year. I deny this personal curriculum request. Signature of Superintendent/Designee: Date:
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