Caldwell west caldwell public schools james caldwell high school

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265 Westville Avenue

West Caldwell, New Jersey 07006


STUDENT NAME: ___________________________________

Independent Study Information

To receive academic credits, the requested program must meet the following standards:

The activity’s “sponsor” must be a certified teacher associated with the Caldwell- West Caldwell Public School District, and
All Independent Study forms must be properly completed and submitted to the Guidance Office for approval prior to the student engaging in the activity.
The student acknowledges that Independent Study courses are taken on a “Pass-Fail” basis. Number grades will not be awarded. Credit value will be determined during consultations among the student, the sponsoring teacher and the student’s guidance counselor PRIOR TO THE START OF THE STUDENT’S INDEPENDENT ACTIVITY.
Transportation is the student’s responsibility. An additional letter signed by a parent must be filed in the main office prior to the start of the student’s independent study.
While a student’s involvement in other activities may be acknowledged on that student’s high school transcript (in the activities section), the standards indicated above must be met in order for an activity to be considered for and to receive Independent Study credits. If you have any questions, please see your guidance counselor.



Statement of Purpose: Objectives of the independent study


Goals: To be developed cooperatively with your advisor


Timetable: A sequential plan for reaching your objectives. This mechanism will serve to both enhance the quality of your project and to allow your advisor to check your progress on a regular basis. Any change to your plan must be approved by your advisor. A written revision must be forwarded to your counselor. Please disclose your timetable below:


A Plan for Evaluation: Establish a means by which you and your advisor may determine whether and to what extent you reached your stated goal and objectives. i.e.-examination, oral presentations, research paper, etc.

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  1. A personal contact (conference or phone call) must be made by the counselor to the parents of the student involved to gain approval and explain the Independent Study project.

  1. A complete plan must be on file with the necessary signatures prior to beginning the project.

  1. A copy of the completed project write-up and evaluation must be sent to student’s counselor and filed in the student’s guidance file.

  1. If at any time the advisor feels that the project should be terminated, a conference should be arranged by those individuals who approved the plan, including the student, to determine the next step (return to the regular program or a change in project plan, etc.)


Date proposal initiated: _______________________________________________

Date of Student/Advisor interview: _____________________________
Expected date of completion: __________________________________________

Will Independent Study necessitate the student leaving the building to complete the proposal?  Yes  No

If yes, parent must sign below and indicate mode of transportation.

My child has permission to  Walk  Drive  Other ____________ to the Independent Study site.

Signature of Parent or Guardian: _______________________________________
Name & School of Faculty Advisor: ____________________________________

Please PRINT

Signature of Faculty Advisor: __________________________________________
Signature of Counselor: ______________________________________________
Signature of Principal: _______________________________ Date:____________

Copies of Proposal to:

Principal  Counselor 

Advisor  Student 

Course # assigned: ________________________
Number of credits to be awarded: ____________
Computer entry initial: ____________________ Date: ___________

Revised 6/27/2017

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