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54

List any additional information which should be reviewed by the ELP Committee as your application for

ELP is considered.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Student Signature: ________________________________

Date: ________________

Parent Signature: _________________________________

Date: ________________

Teacher Signature: ________________________________

Date: ________________

Administrator Signature: ____________________________

Date: ________________

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TO BE COMPLETED BY THE INDEPENDENT STUDY COMMITTEE

This application for independent study has been reviewed by this committee and the following action has been

taken:

ELP project approved

Date: _______________

ELP project approved but with

attached recommendation for changes

Date: _______________

ELP project is not approved

Date: _______________

Comments: ____________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________