1 North Dundas District High School Interdisciplinary Studies Course Outline Course Code: IDC 4UL Course Code: PLF 4C Teacher: Mrs. C. Williams Credit Value: One Credit Course Level: University Course Level: College Pre-requisite: None Link Crew is an interdisciplinary program that promotes the philosophy of students helping students succeed. Link Crew is a structured program that provides senior students with leadership training and opportunities as they mentor grade 9 students in order to help facilitate the transition into secondary school, in an effort to create relationships and a positive school environment. The program provides students the opportunity to develop and reflect upon personal leadership skills, organization and communication skills in order to become positive role models, motivators and peers. The benefits include an increased sense of community, improved school climate, and successful transition of new students. GOALS OF THE INTERDISCIPLINARY COURSE (IDC) PROGRAM In an unpredictable and changing world, students today face an unprecedented range of social, scientific, economic, cultural, environmental, political, and technological issues. The term interdisciplinary is used to describe an approach to learning and knowledge that integrates and benefits from the understanding and application of the approaches of different subjects and disciplines. Students require transferable abilities, such as the skills of effective team building, leadership, and collaborative decision making. Students develop new methods and forms of analysis, interpretation, synthesis, and evaluation that will allow them to build on skills acquired through the core curriculum. Students with well-developed information and management skills and knowledge should have increased marketability and opportunity in a variety of careers. As students enter the world of work, either independently in new ventures or interdependently as part of project teams, they will also need to be enterprising and flexible. Interdisciplinary Studies is a subject area on its own in the Ontario curriculum. This innovative program allows courses to be created and developed that meet the needs, passions and understandings of Ontario s students. In essence, an IDC combines its own unique course elements and learning strands with selected expectations from two or more courses that already exist within the Ontario Curriculum. Every interdisciplinary course focuses on the following goals: 1. Respond to a world that is increasingly interconnected and interdependent. 2. Create new forms of collaboration and transform the nature of work and learning 3. Form new perspectives from ideas and implement them into innovative and lasting solutions. 4. Relate research skills, information management, critical and creative thinking, and technological applications. These goals are reflected within each strand to assess and evaluate student achievement. In their focus on real-life contexts, interdisciplinary studies courses tend to be highly motivating.
2 Course Description This course will help students develop and consolidate the skills required for and knowledge of different subjects and disciplines to solve problems, make decisions, create personal meaning, and present findings beyond the scope of a single subject or discipline. For this Interdisciplinary Leadership Course content will be adapted from the following courses: Business Leadership - Management Fundamentals (BOH4M); Challenge and Change in Society (HSB4M); English (ENG4U); Leadership and Peer Support (GPP3O); and Recreation and Fitness Leadership (PLF4C). Students will apply the principles and processes of inquiry and research to effectively use a range of print, electronic, and mass media resources; to analyse historical innovations and exemplary research; and to investigate real-life situations and career opportunities in interdisciplinary leadership endeavours. They will also assess their own cognitive and affective strategies, apply general skills in both familiar and new contexts, create innovative products, and communicate new knowledge. Textbook: None assigned will draw from numerous resources. Units of Study Unit 1 Team and Climate Building ~ hours Unit 2 Organization ~ hours Unit 3 Leadership ~ hours Unit 4 Communication ~ hours Unit 5 Facilitation/Teaching ~ hours Contacting the Instructor: I may be reached at the school at (ext. 4856) and also by at: Assessment and Evaluation Each unit will be evaluated using the Ministry of Education s Achievement Chart for Interdisciplinary Studies (attached). You will be assessed and evaluated in the areas of your Knowledge/Understanding, Thinking/Investigation skills, Communication and ability to Apply your knowledge to new problems. Each strand will have a major summative evaluation, as well as multiple formative assessments. There will be three culminating activities. Course Breakdown by Achievement Category Knowledge and Understanding 25% Thinking and Investigation 25% Communication 25% Application 25% Final Grade Determination Term Work (journals, event planning, survey, tests, lesson plan) 70% Culminating Activity 1 ( Portfolio/presentation) Culminating Activity 2 (exit interview) Culminating Activity 3 (Reflection) 10% 10% 10% 30%
3 Overall Expectations As the IDC is a subject on its own in the Ontario curriculum, it has a series of overall expectations which need to be met for successful completion of this course, in addition to the overall expectations adapted from each of the courses mentioned in the Course Description. IDC 4U: OVERALL CURRICULUM EXPECTATIONS THEORY AND FOUNDATION demonstrate an understanding of the key ideas and issues related to each of the subjects studied; demonstrate an understanding of the different structures and organization of each of the subjects studied; demonstrate an understanding of the different perspectives and approaches used in each of the subjects studied; demonstrate the skills and strategies used to develop interdisciplinary products and activities. PROCESSES AND METHODS OF RESEARCH be able to plan for research, using a variety of strategies and technologies; be able to access appropriate resources, using a variety of research strategies and technologies; be able to process information, using a variety of research strategies and technologies; be able to assess and extend their research skills to present their findings and solve problems. IMPLEMENTATION, EVALUATION, IMPACTS, AND CONSEQUENCES implement and communicate information about interdisciplinary endeavours, using a variety of methods and strategies; evaluate the quality of interdisciplinary endeavours, using a variety of strategies; analyse and describe the impact on society of interdisciplinary approaches and solutions to real-life situations; analyse and describe how interdisciplinary skills relate to personal development and careers.
4 Course Overview and Overall Curriculum Expectations: Units and Culminating Activities Unit 1 Team and Climate Building Reflective Journal Entries Overall Expectations Addressed GPP3O PKM1. Explain how their personal characteristics and acquired skills may affect their interactions with others in leadership and peer support roles; GPP3O IKS1. Use strategies that promote positive inter personal relationships as they pertain to leadership and/or peer support; PLF 4C L3. Demonstrate an understanding of the group development process; PLF4C L4. Demonstrate teamwork skills that achieve positive results; BOH4M L2. Demonstrate an understanding of group dynamics; BOH4M L3. Demonstrate an understanding of proper leadership techniques in a variety of situations. Unit 2 Organization Event Planning and Critique Unit 3 Leadership Test Unit 4 Communication Survey (design, deliver, analyze, present) GPP3O IKS2. Demonstrate effective use of communication skills in a variety of settings; GPP3O EO2. Demonstrate the ability to design and implement a plan or program that addresses needs identified in the school or the community; BOH4M L2. Demonstrate an understanding of group dynamics; BOH4M L3. Demonstrate an understanding of proper leadership techniques in a variety of situations; BOH4M PC1. Analyse the importance of planning to the success of an organization; BOH4M PC2. Demonstrate an understanding of appropriate planning tools and techniques in a variety of situations. GPP3O PKM2. Identify the characteristics of an effective leader and use these to evaluate their own leadership and peer support capabilities; GPP3O PKM3. Identify and apply the personal-management skills and characteristics required to succeed in leadership and peer support roles; GPP3O IKS2. Demonstrate effective use of communication skills in a variety of settings; ENG4U W1. Developing and Organizing Content: generate, gather, and organize ideas and information to write for an intended purpose and audience; PLF4C L1. Analyse a variety of leadership styles; HSB4M HI4. Demonstrate an ability to select, organize, and interpret information gathered from a variety of print and electronic sources; HSB4M HI5. Communicate the results of their inquiries effectively. GPP3O IKS2. Demonstrate effective use of communication skills in a variety of settings; ENG4U W1. Developing and Organizing Content: generate, gather, and organize ideas and information to write for an intended purpose and audience; HSB4M ST2. Assess the importance of demography as a tool for studying social trends; HSB4M ST3. Demonstrate an understanding of the social forces that influence and shape trends; HSB4M HI4. Demonstrate an ability to select, organize, and interpret information gathered from a variety of print and electronic sources; HSB4M HI5. Communicate the results of their inquiries effectively. Unit 5 Facilitation/Teaching Lesson Plan and Delivery (peer and self-assessment) GPP3O PKM3. Identify and apply the personal-management skills and characteristics required to succeed in leadership and peer support roles; GPP3O PKM4. Identify and apply effective teaching and learning strategies and resources to help others through leadership and peer support roles. GPP3O IKS2. Demonstrate effective use of communication skills in a variety of settings; GPP3O EO2. Demonstrate the ability to design and implement a plan or program that addresses needs identified in the school or the community; BOH4M L2. Demonstrate an understanding of group dynamics; BOH4M L3. Demonstrate an understanding of proper leadership techniques in a variety of situations; BOH4M PC1. Analyze the importance of planning to the success of an organization.
6 ROLES AND RESPONSIBILITIES IN THE INTERDISCIPLINARY STUDIES PROGRAM STUDENTS Students have many responsibilities with regard to their learning, and these increase as they advance through secondary school. Students who are willing to make the effort required and who are able to monitor their thinking and learning strategies and apply themselves will soon discover there is a direct relationship between their effort and their achievement. Students need to understand that problem solving of any kind often requires a considerable expenditure of time and energy and a good deal of determination. Character Education is an important part of achieving success in the classroom and beyond; as such students are encouraged to use the eight virtues of Character Education (Caring, Empathy, Fairness, Honesty, Perseverance, Resilience, Respect, and Responsibility) in their thought processes and actions. In order to achieve success in the Interdisciplinary Studies program, students will develop and refine their investigation skills, their problem-solving skills, their critical and creative thinking skills and their communication skills. Students are required to have a sincere commitment to work and to the development of appropriate Learning Skills (Responsibility, Organization, Independent Work, Collaboration, Initiative, and Self-Regulation). Students also have a responsibility to know and understand all Health and Safety precautions which will be outlined and demonstrated by the classroom teacher. All students are expected to model all safety practices at all times when in the school, thus ensuring personal safety and the safety of others. PARENTS/GUARDIANS Students perform better in school if their parents/guardians are involved in their education. Effective ways in which parents/guardians can support their children s learning include, but are not limited, to the following: Ensuring their children arrive to class with the necessary materials. Ensuring their children complete all assigned work. Encouraging their children to review notes and concepts to help reinforce their understanding and ensure that synthesis of learning has occurred. Encouraging their children to seek help from the teacher at the first sign of struggle. Early clarification and support reduces the likelihood of increased gaps in learning. Supporting the school s character education philosophy and the criteria of the learning skills by modeling the eight virtues and encouraging their children to demonstrate these positive behaviours consistently at home. Contacting the teacher regularly to promote open two way communication between the home and school, so the teacher can employ strategies to best support their children. Attending parent-teacher interviews and school council meetings. TEACHERS Teachers are responsible for developing appropriate instructional strategies to help students achieve curriculum expectations, as well as appropriate methods for assessing and evaluating student learning. Teachers bring enthusiasm and varied teaching and assessment approaches to the classroom, addressing individual students needs and ensuring sound learning opportunities for every student. Using a variety of instructional, assessment, and evaluation strategies, teachers provide numerous hands-on opportunities for students to discover fundamental concepts through inquiry, exploration, observation and research. Teachers encourage students to investigate, to reason, to explore alternative solutions, and to take the risks necessary to become successful problem solvers and life-long learners. Teachers will embed the eight virtues of character education into their daily lessons and will model appropriate behaviours for their students. Teachers are also responsible for ensuring the safety of students during classroom activities and for encouraging and motivating students to assume responsibility for their own safety and the safety of others.
7 The Importance of Evaluation The 70% term mark will be determined by the student s achievement of the Ontario Ministry of Education s Senior Interdisciplinary Studies Curriculum for IDC 4U. Each evaluation task is a critical component of a student s term mark and it is therefore imperative that students participate in and complete every evaluation. For students who fail to complete an evaluation, a contract (see attached) will be put in place. This contract will renegotiate the date of completion for that evaluation piece, in consultation with both the student and the parent / guardian. Students who then fail to meet the conditions of the contract may be putting their term mark in jeopardy, i.e. Level R (40), which is indicative of one or more overall expectations that has not been met to a minimum of Level 1, or Level R- (20), which is indicative of insufficient evidence of essential learnings in order to demonstrate one or more overall expectations to a minimum of Level 1. As a part of the contract, students may be required to complete outstanding evaluations during the noon hour (10:50 am 11:45 am). Students will be permitted to bring their lunch with them as they work to complete the evaluation task. If necessary, additional school strategies may be implemented to support student learning and ensure all opportunities to demonstrate course expectations are met. In order to properly prepare students for the evaluation of overall expectations, they will be presented with multiple assessment opportunities to demonstrate prior learning of specific and overall expectations from the Ontario Ministry of Education's Senior Interdisciplinary Studies Curriculum for IDC 4U. Reporting on Demonstrated Learning Skills The report card provides a record of the Learning Skills (see attached chart) demonstrated by the student in every course, in the following six categories: Responsibility, Organization, Independent Work, Collaboration, Initiative, and Self-Regulation. The Learning Skills are evaluated using a four-point scale (E Excellent, G Good, S Satisfactory, N Needs Improvement). The separate evaluation and reporting of the Learning Skills in these six areas reflects their critical role in students achievement of the curriculum expectations.
8 Achievement Chart Grades 11 and 12 Interdisciplinary Studies Categories 50-59% (Level 1) 60-69% (Level 2) 70-79% (Level 3) % (Level 4) Knowledge/Understanding - Subject-specific content acquired (knowledge), and the comprehension of its meaning and significance (understanding) knowledge of facts and ideas demonstrates limited knowledge of relevant facts and ideas demonstrates some knowledge of relevant facts and ideas demonstrates considerable knowledge of relevant facts and ideas understanding of concepts (e.g., demonstrates limited demonstrates some demonstrates considerable connectedness, interdependence, multiple understanding of required understanding of required understanding of required perspectives) concepts concepts concepts understanding of relationships between demonstrates limited demonstrates some demonstrates considerable concepts and/or disciplines understanding of relationships understanding of understanding of required between concepts and/or relationships between concepts disciplines concepts and/or disciplines Thinking and Investigation - The use of critical and creative thinking skills and inquiry, research, and problem-solving skills and/or processes use of thinking skills that go beyond the scope uses a limited range of thinking uses a moderate range of uses a considerable range of of a single discipline (e.g., prioritizing, solving skills thinking skills thinking skills problems, making analogies, predicting, inferring, reasoning) use of critical-thinking skills (e.g., problem solving from multiple perspectives, decision making that uses a systems approach) application of an inquiry/research process (e.g., formulating questions, planning, selecting resources and technologies, analysing and evaluating information) to understand interdisciplinary relationships application of creative thinking skills (e.g., generating models of thinking and synthesis) uses critical-thinking skills with limited insight and applies a few of the required skills and strategies of an inquiry/research process applies creative skills with limited and innovation Communication - The conveying of meaning through various forms communication of information and ideas communicates information and ideas with limited clarity collaboration (e.g., interactive listening, team building, cooperative planning, leadership) use of language, symbols, media, and technologies communication for different audiences and purposes in real life situations across the disciplines use of various communication forms and technologies collaborates with others with limited uses language, symbols, media, and technologies with limited accuracy and communicates with a limited awareness of audience and purpose uses critical-thinking skills with some insight and applies some of the required skills and strategies of an inquiry/research process applies creative skills with some and innovation communicates information and ideas with some clarity collaborates with others with some uses language, symbols, media, and technologies with some accuracy and communicates with some awareness of audience and purpose demonstrates limited demonstrates some command of various forms and command of various forms technologies and technologies Application - The use of knowledge and skills to make connections within and between various contexts application of ideas and skills in familiar applies ideas and skills in contexts familiar contexts with limited application of ideas and skills in new contexts applies ideas and skills in new contexts with limited application of processes and technologies applies processes and (e.g., the research process, multimedia and technologies with limited telecommunications technologies) and creativity provision of explanations that incorporate new understandings finding connections (e.g., among disciplines, between a discipline and the world outside the school) provides explanations that incorporate a few new personal understandings finds connections with limited success applies ideas and skills in familiar contexts with some applies ideas and skills in new contexts with some applies processes and technologies with some and creativity provides explanations that incorporate some new personal understandings finds connections with some success uses critical-thinking skills with considerable insight and applies most of the required skills and strategies of an inquiry/research process applies creative skills with considerable and innovation communicates information and ideas with considerable clarity collaborates with others with considerable uses language, symbols, media, and technologies with considerable accuracy and communicates with considerable awareness of audience and purpose demonstrates considerable command of various forms and technologies applies ideas and skills in familiar contexts with considerable applies ideas and skills in new contexts with considerable applies processes and technologies with considerable and creativity provides explanations that incorporate a considerable number of new personal understandings finds connections with considerable success demonstrates thorough knowledge of relevant facts and ideas demonstrates thorough and insightful understanding of required concepts demonstrates thorough understanding of relationships between concepts and/or disciplines uses a wide range of thinking skills confidently and effectively uses critical-thinking skills with a high degree of insight and applies all or almost all of the required skills and strategies of an inquiry/research process applies creative skills with a high degree of and innovation communicates information and ideas with a high degree of clarity collaborates with others with a high degree of uses language, symbols, media, and technologies with a high degree of accuracy and communicates with a high degree of awareness of audience and purpose demonstrates extensive command of various forms and technologies applies ideas and skills in familiar contexts with a high degree of applies ideas and skills in new contexts with a high degree of applies processes and technologies with a high degree of and creativity provides explanations that incorporate a significant number of new personal understandings finds connections with a high degree of success Note: A student whose achievement is below 50% at the end of a course will not obtain a credit for the course.
9 Learning Skills Chart Learning skills are grouped under the following six headings: Responsibility, Organization, Independent Work, Collaboration, Initiative, and Self- Regulation. For each of these six categories of learning skills, a checklist of sample behaviours is provided. Responsibility Fulfils responsibilities and commitments within the learning environment. Completes and submits class work, homework, and assignments according to agreed-upon timelines. Takes responsibility for and managing own behaviour. Organization Devises and follows a plan and process for completing work and tasks. Establishes priorities and manages time to complete tasks and achieve goals. Identifies, gathers, evaluates, and uses information, technology and resources to complete tasks. Independent Work Independently monitors, assesses, and revises plans to complete tasks and meet goals. Uses class time appropriately to complete tasks. Follows instructions with minimal supervision. Collaboration Accepts various roles such as motivating and encouraging others to participate and taking on an equitable share of the work. Responds positively to the ideas, opinions, values, and traditions of others. Builds healthy peer to peer relationships in person and through personal and media-assisted interactions. Works with others to resolve conflicts and build consensus to achieve group goals. Shares information, resources, and expertise and promotes critical thinking to solve problems and make decisions. Initiative Looks for and acts on new ideas and opportunities for learning. Demonstrates the capacity for innovation and a willingness to take risks. Demonstrates curiosity and interest in learning. Approaches new tasks with a positive attitude. Recognizes and advocates appropriately for the rights of self and others to seek assistance when needed and utilizing appropriate supports. Self-Regulation Sets own individual goals and monitoring progress towards achieving them. Seeks clarification or assistance when needed. Assesses or reflects critically on own strengths, needs and interests. Identifies learning opportunities, choices and strategies to meet personal needs and achieve goals. Perseveres and makes an effort when responding to challenges.
10 Classroom Expectations 1. Do Your Best. This means attending classes, paying attention, fulfilling your responsibilities to your LINK Crew Grade 9s, doing your homework, asking questions for clarification, behaving respectfully and taking responsibility for your own academic success. 2. Be Present. Due to the interactive and participatory nature of this course, you are strongly encouraged to participate fully in every class. If you are absent, you are responsible for catching up on missed notes or handouts and to see what occurred in the classes you are mentoring. 3. Be Punctual. Being late hinders your ability to learn effectively and disrupts the learning of others. If you are late, you must take responsibility for the work you have missed. Students who are late may be assigned a 5 minute detention immediately after class, unless they are late for the last period of the day and will serve their detention after class on the following day. 4. Be Ready to Learn. Bring all of the following required materials to class every day: binder, paper, pen, pencil. 5. Be Safe. Backpacks and coats are not permitted in class. 6. Be Productive. This means: Be positive and open-minded. This course will challenge you, putting you in situations that may initially be outside your comfort zone. Come to class with a positive attitude and remember... GO BIG!!! Stay in class. To maximize student learning, students will not be permitted (unless in emergency or for health reasons) to leave the room during a lesson to go to the washroom, get a drink of water, etc. Use class time to your advantage. Participate fully in all activities, complete all in-class work. Respect the learning environment. If you wish to listen to music when completing independent work, you must first ask for permission if granted please use headphones and keep the volume at a reasonable level. Minimize distractions. Please do not bring cell phones to class; if you do bring a cell phone to class it is to be OFF. This means that students cannot use them as calculators, telephones, cameras, game consoles or for any other purpose during class time unless permission is granted by the classroom teacher. 7. Seek Extra Help. If you are struggling with any concept or requirement of this course, ask for help. 8. Tests and other Evaluations. There will be at least one week s advisement of upcoming tests or assignments. You are to be prepared to write the test or submit the assignment on that date during the class time allotted. If you follow the classroom expectations outlined above, you will be prepared for tests. There will always be at least one review period prior to the test date. You must learn to organize your time so you are prepared for the test on the assigned date, regardless of the other commitments you have (e.g. sports, job, other tests and assignments). If you will be absent on a test date you must make the appropriate arrangements with the classroom teacher. 9. Assessments. You will have many opportunities to receive feedback on your learning in the form of homework checks, quizzes, assignments and projects. These assessment items will not factor into your overall mark in the course. However, you are strongly encouraged to submit all items for assessment in order to learn from the feedback provided, and to prepare more thoroughly for evaluations (assignments, projects, presentations, etc.). 10. Culminating Activities. These are major evaluation items that must be submitted on the assigned due date. A completion contract will be implemented if you do not respect due dates. 11. Accommodations and Alternate Learning Environments. All students have unique patterns of learning. The classroom teacher will ensure that students who require instructional, environmental or assessment accommodations (i.e. students with IEPs, English Language Learners, First Nations students, etc.) will have these supports put in place to ensure an accurate measure of the student s skills and knowledge.
11 Completion Contract for Outstanding Evaluation Tasks Student Name: Teacher Name: Mr. C. Williams Name of Evaluation Task: Description of Evaluation Task Course Code: IDC 4U Overall Expectation(s) Addressed Original Due Date: Renegotiated Due Date: Accommodations made to Evaluation Task Student Signature: Date: Parent / Guardian Signature: Date: Teacher Signature: Date: ** Students who do not fulfill the conditions of the Completion Contact understand that they will receive a "NO MARK" for this evaluation task which may put their term mark in jeopardy, i.e. Level R (40), which is indicative of one or more overall expectations that has not been met to a minimum of Level 1, or Level R- (20), which is indicative of insufficient evidence of essential learnings in order to demonstrate one or more overall expectations to a minimum of Level 1. **
12 Referencing in Interdisciplinary Studies There are two basic referencing styles MLA and APA and many versions within each of these two styles. I encourage you to choose a consistent referencing style, regardless of the subject area we happen to be focussing on in the course. There are two types of citations.in-text and Bibliographic. You must have BOTH types of references in any report you submit. 1. Books Bibliography: McCormac J.S., Kennedy G Birds of Ohio. Auburn (WA): Lone Pine. p In-Text: (McCormac and Kennedy 2004) 2. Web Sites IN GENERAL Provide sufficient information to allow a reader to locate the source you are citing. Web documents share many elements found in print sources. The citation for a Web document often follows a format similar to that for print, with some information omitted and some added. Cite what is available when you cannot find some elements of information about a source. For example, publication dates may not be provided for some online information sources. Include the date that you accessed the source. Cite the address (URL) accurately. If it is necessary to divide the URL between two lines, break only after a slash mark and do not insert a hyphen at the break. Web Page (With No Author Listed) Bibliography: Emerald Ash Borer (EAB) [Internet]. [updated 2007 Feb 27]. Columbus (OH): Ohio Department of Natural Resources, Division of Forestry; [cited 2007 Jul 24]. Available from: In-Text: (Emerald Ash Borer... [updated 2007]) FOR ADDITIONAL REFERENCE MATERIALS, SEE or tegoryid=15&category=citation%20%2f%20style%20guides
13 Communicating with Parents / Guardians November 5, 2012 Dear Parents/Guardians, I look forward to being a partner with you to ensure your child s successful completion of the Link Crew course. I expect that your son/daughter will attend all classes, catch up on missed work and submit all assignments on time. I believe that you and I can work together to encourage our students to develop those skills which will help them to be successful beyond their high school career (ie. Respecting due dates; taking responsibility for their actions; showing initiative; respect always). Throughout the semester, please feel free to contact me at any time. You can contact me by calling the school at (613) (ext. 4856) or by ing me at Through , I can easily and efficiently provide you with information that is relevant to you and your child, including assignments and progress reports. Please sign and date this letter to show that you have read it, as well as the accompanying course outline, and if applicable provide an address that you access regularly on the space provided below. If you have any concerns, please communicate them to me on the back of this letter. Thank you in advance for your participation and support in your child s education this semester. Sincerely, Mrs. C. Williams STUDENT NAME Parent /Guardian Name (please print) Signature Date Methods of Communication: (provide current address) Phone: Home Cell Work Convenient times to call (circle all that apply): anytime morning afternoon evening other: Phone: Home Cell Work Convenient times to call (circle all that apply): anytime morning afternoon evening other: Phone: Home Cell Work Convenient times to call (circle all that apply): anytime morning afternoon evening other: ** Please place an asterisk (*) beside your preferred method of communication **
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