High School Driver Education Courses Summer 2014

Important information: To avoid delay in the processing of your application, please read the following pages completely and carefully. Schedule Code 399

Course Safety

Dates 6/9-6/27

Times 8:15 a.m.-10:15 a.m. (M-F) or 10:15 a.m. –12:15 p.m. (M-F)

Cost $50.00 ($150 out-of-district)

499

Behind-the-Wheel I (BTW I)

6/9-7/3

1 ½ hours per day, 2 days/wk. Options: M/Tu, W/Th, or F/Sa

$200.00

499

Behind-the-Wheel II (BTW II)

7/7-8/1

1 ½ hours per day, 2 days/wk. Options: M/Tu, W/Th, or F/Sa (F/Sa offered only if enrollment warrants.) Times assigned.

$200.00

Students who completed Safety during the school year will be placed in BTW I unless they specifically request BTW II. Students taking Safety during the summer session will automatically be assigned to BTW II, if they request instruction. Registration Complete the attached registration form and return it and the appropriate fee to either of the two high school main offices by May 9, 2014. If you want to be considered for Behind-the-Wheel based on your birthday, a completed form and payment must be received by May 9, 2014. After this date, assignment will be done on a first-received basis. All fees must be paid at the time of registration. Confirmation of students’ assigned Safety and/or BTW schedules should be received in students’ homes no later than May 24, 2014. Parents/students are asked to refrain from calling the summer school office to check on students’ assignments until AFTER written confirmation is received. Fees (Resident) Safety (Classroom Driver Education) Behind-the-Wheel (Driver Training)

$50.00 $200.00

Fees (Nonresident) Safety (Classroom Driver Education) Behind-the-Wheel (Driver Training)

$150.00 $200.00

Fee Waiver Unit 4 students who are eligible for free or reduced lunch will be granted a fee waiver for summer school. No fee waivers will be granted to nonresident students. Nonresident Students Champaign Unit #4 students will be given preference for scheduling. Non-residents will be scheduled where space is available.

Tuition Refunds Refunds, if requested will be granted up to the first day of class. Attendance Since summer school is a concentrated program, regular attendance is required. A student will be allowed to miss only two days during Safety. (It is the responsibility of the student to make up his/her time.) Due to the large number of students enrolled in Behind-the-Wheel, it is essential that students attend each session at their regularly scheduled time. Absences in Behind-the-Wheel could result in students being dropped from their assigned session. Final Examination Policy (Safety) Attendance is mandatory on the day of the final examination. Students not in attendance will forfeit their credit and fees. FINAL EXAMINATIONS WILL NOT BE GIVEN EARLY. Schedule Preferences and Changes Students are assigned to Behind-the-Wheel classes according to age with priority given to the oldest. Every effort will be made to accommodate students’ summer schedules provided conflicts are specifically stated on the registration form. Students wishing to change their assigned time or session will be placed on a waiting list and their slot will be reassigned to another student. Schedule changes, therefore, are not encouraged. Eligibility Any student 15 years of age or older by the date of the first class session is eligible to enroll in driver education (Safety/and or Behind-the-Wheel). Students enrolling in either driver education component must have received passing grades in at least eight (8) high school courses in the previous two semesters. Location All Safety and Behind-the-Wheel classes will be held at Centennial High School, 913 S. Crescent Dr., Champaign. Transportation Students who are eligible for free or reduced lunch also qualify for free MTD transportation; however, they must request bus tokens from the summer school office. School Regulations In order to maintain an atmosphere conducive to learning, the same rules and regulations are in effect during summer school as during the regular school year. In cases pertaining to smoking, excessive tardiness, controlled substance abuse, and acts of gross misconduct, a student may be dismissed from summer school immediately. Dismissal from summer school will result in forfeiture of credit and fees.

2014 High School Summer School – CUSD #4  Driver Education Course Enrollment Form    Please PRINT the following information using a black or blue pen.  Do not use pencil.  Once you complete the following  information, see the reverse side to choose courses of enrollment.  Completed forms are due Friday, May 9, 2014.  Current  Unit 4 students should submit this completed form and fee payable to CUSD #4, if applicable, to their high school counseling  office.  Students currently enrolled in non‐Unit 4 schools should submit this form, along with the appropriate fee, to the Mellon  Administrative Center, 703 S. New Street, Champaign.  All non‐Unit 4 students’ forms must be signed by a counselor or  administrator from the home school. 

   

Student Last Name:    Address:  

 

First Name: 

   Middle Initial: 

   

Number & Street 

 

 

 

 

 

 

 

 

 

City 

 

 

 

Zip Code 

 

Home Number:   

 

Cell Number:   

 

 

  Birth Date: 

  Hispanic/Latino Ethnity:   Yes  or  No      Native/Home Language:   

 

Gender:    Male    Female              (circle one) 

                  Month/Day/Year 

 

 

 

 

 

 

 

                   (Circle one) 

  Race:   White___    Black___     Asian___     American Islander/Alaskan___     Pacific Islander___     Multi‐Racial___   

 

 

     

 

 

 

 

 

School Attended Last Semester: 

 

Grade:   

 

 

 

 Cell Phone: 

 

 

 

 

 

 

13/14 School Year 

    Parent/Guardian Name: 

 

Day Phone: 

 

 

                                                                     First Name                                            Last Name                                                

Emergency Contact:   

 

 

  Emergency Phone:  

(If parent/guardian cannot be reached)   

Physician Name:    Heath Restrictions: 

   

 

 

 Phone Number:   

 

 

 Hospital:  

 

 

 

 

 

 

 

 

 

 

 

 

 

  EMERGENCY RELEASE:  In an extreme emergency, your child will be taken by ambulance to the hospital that you identify below.  In case of a lesser emergency,  efforts will be made to contact you for your direction.  All medical fees are the responsibility of the parent/guardian. 

  In an extreme emergency, my child should be taken to:    Carle     Provena Covenant 

  Parent/Guardian Signature:   

 

 

 

 

 

 

  Date:   

 

 

 

 

FOR OFFICE USE ONLY:  Qualified for free/reduced lunch or fee waiver during the 13‐14 school year or have newly approved waiver on file:      Y     N    I certify that the above‐named student has received passing grades in at least eight (8) high school courses in the previous two  semesters and is AGE ELIGIBLE (15 by the first day of enrollment) to enroll in driver education instruction.     

Counselor Signature:  ____________________________   Secretary Signature:  ____________________________    (For verification that course is entered in eSchool)                                     (For verification of free/reduced lunch or fee waiver qualification only) 

 

Student Name:  ________________________________   

Place a checkmark () or an “x” () in the box next to the course the student is requesting for  each summer term.  Students may only take one course each semester.   

CLASSROOM DRIVER EDUCATION Students must complete Safety before enrolling in Behind‐the‐Wheel.   

Summer Term 1:  6/9/14 to 6/27/14 Choose only one class.   

SAFETY 

8:15 a.m. to 10:15 a.m. 

 

SAFETY 

10:15 a.m. to 12:15 p.m. 

BEHIND‐THE‐WHEEL DRIVER EDUCATION Students should only enroll in Behind the Wheel for one term.  Students must successfully  complete one term of Safety before enrolling in Behind the Wheel instruction.  

Summer Term 1:  6/9/14 to 7/03/14

Summer Term 2:  7/7/14 to 8/1/14

Choose only one class each semester.

Choose only one class each semester. 1.5 hrs. per day, 2 days/wk.,  BTW II  M/Tu, W/Th*, or F/Sa as  assigned.

 

BTW I 

1.5 hrs. per day, 2 days/wk.,  M/Tu, W/Th, or F/Sa as assigned. 



  Behind‐the‐Wheel Scheduling Conflicts:    Please list dates, days of the week, &/or times that you are UNABLE to participate in Behind‐the‐Wheel.  We will  do our best to accommodate your personal schedule but cannot guarantee a particular session, pair of days, or  time.  Sessions begin at 7:00 a.m. and are scheduled every 1.5 hours with the final session concluding at 7:00 p.m.   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Students who have completed Safety and are enrolling in the Behind-the-Wheel component must present evidence of satisfactory completion of the classroom instruction component. In order to do this, the form below must be completed. Certificate of Satisfactory Completion of Safety Complete this form ONLY if you have satisfactorily completed Safety and are enrolling in Behind-the-Wheel. Return this form with your application and fees.

Name*_________________________________________________________________________________________ Last First Middle

Date of Birth ____________________________ Phone _________________________________________________

Street Address __________________________________ City _______________________________ Zip __________ Date ______________________________________ Signature ____________________________________________ Safety Instructor’s Signature *Provide name as listed on student’s birth certificate.