Le Mars Community High School

P a g e | 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: ________________ --------------------------------------------------------------------------------------------------------------------- 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: ____________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

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