English- ASP application form 2011-2012


2011-2012 After School Program Registration Form

Blaker-Kinser Junior High School

School Site _____ Student ID # ______ Student Name_______________________________ Grade _____

              Last Name                           First Name

Circle YES or NO and sign to indicate your choice. ALL FORMS MUST BE RETURNED.

I understand that my child has been recommended for retention. I want my student placed in an After School Program class. I have read and discussed with my son/daughter the general information and After School Program rules below and I understand and will support these guidelines.

I do NOT want my student placed in an After School Program class. I understand by not participating, my son/daughter is at risk of not earning sufficient credits to participate in graduation and may be retained.

_____________________________ _____________________________

Parent Signature                           Date        Student Signature                         Date

Your child will be assigned to a Math or Language Arts class most appropriate for his or her needs.

Classes are: Tuesday, Wednesday, Thursday 2:30 – 4:00

First Quarter 8/23-10/13 (8 weeks/24 days)                        Third Quarter 1/10-3/8 (7 weeks/22 days)

Second Quarter 10/25-12/14 (8 weeks/23 days)                  Fourth Quarter 3/20-5/10 (7 weeks/21 days)

Excessive absences or tardies are not permitted. Absences may affect the student’s credits. Students missing more than 6 days or not attending the first week may be dropped from their class in the program.

In order to earn the 2.5 credits for the class and get the academic benefits students must attend at least 75% of the quarter and complete class work satisfactorily.

Students are expected to follow all school rules. Excessive referrals (3) from a teacher will result in the student being dropped from the class. Any offense that would result in suspension during the regular school year will result in the student being dropped from the class.

All Students Will Abide by the Following Rules:

  • No food or drinks will be allowed in classrooms.
  • No breaks will be allowed outside the classroom.
  • One student will be allowed out of the classroom at a time to use the restroom.
  • Respect the right of others to study and learn by not being disruptive.
  • No cell phones or electronic devices.
  • Respect all school and private property. Students and parents are responsible for all school materials checked out to students.
  • No possession or use of tobacco products.
  • No caps, hats, or head covering may be worn during class.
  • Obey all Junior High School rules as specified in the Student Handbook. Failure to do so may result in removal from class.
  • Students who cause, or threaten to cause, personal injury to another person, possess or use dangerous objects and/or controlled substances, disrupt school activities, or willfully defy the authority of teachers or other school officials will be dropped immediately from the program.


The above student is recommended for placement in the indicated After School Program class.

_____ 8920 ASP Pre Algebra                                            _____ 8925 ASP Algebra 8

_____ 8900 ASP English Language Arts 7th                      _____ 8905 ASP English Language Arts 8th


Administrator’s Signature                                Date