this is a fill and print form. please save for your ... count … · complete this form for all...
TRANSCRIPT
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 1
This is a fill and Print Form. Please SAVE for your records. FORM VL
DISTRICT: CURRENT SCHOOL YEAR:
BUILDING: COUNT DAY:
I certify that this is a true and accurate list of all virtual learning pupilsand all pupil accounting requirements have been met on Count Day.
Authorized Representative Signature Title Date
INSTRUCTIONS: Complete this form for all pupils enrolled in Virtual Learning options following Section 21f of the State Aid Act and Section 5-O-D of the Pupil Accounting Manual. More than one line may be used for each pupil. Submit two-way mentor contact list with form.
Teacher Name holding MI certificate assigned to course:
On-site mentor name (employed by district):
Program Participation Requirements Met Documentation: Please enter the requirement number met in column I.
1. 4-weeks of two-way interaction 2. Attended EACH virtual course w/live instruction w/teacher on COUNT DAY. 3. Completed course assignment, lesson, or activity for EACH COURSE ON COUNT DAY. 4. Assessed ongoing lessor for EACH COURSE ON COUNT DAY. 5. Physical attendance ON COUNT DAY in EACH course scheduled 56% on-site face-to-face
w/teacher of record (10/30-day rule applies.
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 2
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber.
See
inst
ruct
ions
abo
ve.
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 3
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 4
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 5
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 6
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 7
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 8
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 9
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 10
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 11
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 12
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 13
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 14
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 15
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 16
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 17
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 18
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 19
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N
5-O-D VIRTUAL LEARNING PUPIL LIST
Form VL Page | 20
A. B. C. D. E. F. G. H. I. J. K.
Pupils Legal Name: (Last, First, MI) Grade Course Title
Gen
erat
ed C
redi
t?
Y /
N
Pare
nt C
onse
nt o
r St
uden
t is 1
8 or
old
er?
Y /
N
Cour
se is
boa
rd
appr
oved
? Y
/N
Cour
se is
list
ed in
dis
tric
t co
urse
or M
VU C
atal
og?
Y /
N
Is st
uden
t a se
quen
tial
lear
ner?
Y
/ N
Part
icip
atio
n Re
quire
men
t num
ber?
Y
/ N
Dist
rict d
eter
min
ed in
be
st in
tere
st o
f Pup
il an
d Pu
pil A
gree
s?
Di
stric
t has
doc
umen
ted
EDP
with
requ
ired
item
s?
Y /
N