Credit Flexibility Form
Credit Flexibility Form

Student Information:

Student Name:
Student Grade Level:
Student Phone Number:
Student Address:
Parent/Guardian Name:
Parent/Guardian Phone Number:
Parent/Guardian Address:

Reason for pursuing this program: (Check All That Apply)

If 'Other', was selected, please describe here: 

In your own words, describe more fully why you are selecting this option: 

Plan is for: (Check one) 

If an off-site instruction provide is involved, list the name and location:

Course Information

Course Title:
Department (e.g. science, mathematics):
Teacher of Record:
Date Course Work to Begin:
Date Course Work to End:

Action Plan

Description of what student will do to earn this credit: (check all that apply)

Please clearly and thoroughly explain your proposed course of study. Be sure to answer the following questions below.(For on-line and PSEO courses, attach a course syllabus.) 

1.    What are the goals and objectives that you want to learn?

2.    How are the goals and objectives directly tied to the state standards?

3.    What activities will be completed to support your learning?

4.    What will be your method of assessment? How do you propose showing mastery of your topic? Explain how your choice of assessment will be aligned to Ohio’s Academic Content Standards.

5.    Outline your timeline of study for this course. Be sure to include start date, activity dates, measurement dates, and final presentation date.

Signature of Student:Date:
Signature of Parent:Date:
Signature of Teacher of RecordDate:
Signature of Principal / CounselorDate:


Security Measure