LOS ANGELES UNIFIED SCHOOL DISTRICT

Office of Secondary Instruction

 

APPLICATION AND AUTHORIZATION FORM FOR FOREIGN LANGUAGE CREDIT

(For use in applying for credit for foreign language instruction received in private schools other than regular day or boarding school)

 

PART I.  APPLICATION  (This part is to be completed by the student. Refer to instructions before filling out application)

 

_______________________________________________________   _________________________________

Last Name of Student                                           First                                        Middle                    Birthday – Month            Day                               Year

 

I am now enrolled in grade _______ in __________________________________________________________________

                                                                                Name of LAUSD School                                                       Street Address of School

 

________________________________________________________________  I plan to have, have received, or am now

City                                                                                                        Zip Code

 

receiving instruction in ______________________ in the ___________________________________________________

                                                                Name of Language                                                                Name of Private School

 

While currently enrolled in the Los Angeles Unified School District in grade 9 or above.

 

I have read the instructions at the beginning of this form and hereby make application for credit equivalent

 

to that given to students in the Los Angeles Unified School District for the completion of __________________________

                                                                                                                                                                                                Title of

 

____________________________________________________________________________________________________________

Foreign Language Course or Courses

 

*NOTE: For example, first year foreign languages courses in grades 9-12 are entitled. Japanese 1 AB,

               Hebrew 1 AB, etc. Second year courses are entitled Japanese 2 AB, Hebrew 2 AB, etc.

 

__________________________________________________                 _______________________________________

Signature of Student                                                                                                                                            Date

 

 

COUNSELOR’S ACKNOWLEDGMENT OF INTENTION TO APPLY FOR CREDIT

 

I acknowledge that the student named above, who is now attending  ___________________________________________

                                                                                                                                                                Name of LAUSD School

 

is currently enrolled in grade ________ and is making application for credits as indicated above.

 

_______________________________________________________                    ___________________________________________

Counselor’s Signature                                                                                                                        Date

 

(Counselor’s signature does not indicate approval nor disapproval of the request.)

 

 

PART II.  VERIFICATION OF FOREIGN LANGUAGE INSTRUCTION (This part is to be completed by the

                          Principal of the private school in which the student is enrolled. Please include all information that is requested.)

 

While concurrently enrolled in grade  ________________  in a school of the Los Angeles Unified School District, the

                                                                                                                              9, 10, 11, or 12

 

above named student has received foreign language instruction in the private school of which I am principal.

 

The student received private school instruction in  __________________________________  during his or her

                                                                                                                                                                                                Name of Language                               

                                                                                                                                               

enrollment in grade _______ at __________________________________________ School. The beginning date of

                                                                                                                        Name of LAUSD School      

 

instruction was  _________________________________________

                                  Month                         Day                     Year

 

The ending date of instruction was ______________________________________

                                                                                                                        Month                           Day                     Year

 

The total clock hours of instruction for the year was ________________________

PART III.  AUTHORIZATION OF CREDIT  (To be completed and signed by the principal of the private school)

 

I certify that the student named above has received the foreign language instruction which I have described

in Part II of this form, has satisfactorily passed an appropriate examination, and is therefore entitled to

receive credit for completion of the course as indicated.

 

 

GRADE

 

COURSE TITLE*

AMT.**

OF

CREDIT

MARK

IN

SUBJECT

CLOCK HOURS OF FOREIGN LANG. INSTRUCTION

 

NAME OF PRIVATE SCHOOL

 

 

 

 

 

 

 

 

* Course must be recorded in terms of an equivalent course offered in the Los Angeles Unified School District Course title should therefore correspond to that used in the District: for example, a first-year foreign language course is entitled Japanese 1 AB, Hebrew 1 AB, etc. A second-year course is entitled Japanese 2 AB, Hebrew 2 AB, etc.

**10 credits are granted for a one-year course.

 

Address of Private School  ____________________________________________________________________________

                                                                Number and Street                                                               City                                                        Zip Code

 

___________________________________                _______________________________________________________

                School Phone Number                                                                                                         Principal’s Signature

 

IMPORTANT: This application and authorization form must be mailed directly to the public school which the student is attending at the address shown in Part I of this form and must be postmarked not later than the date of the last day of the current school year of the Los Angeles Unified School District. If the credit for which a 12th grade student has applied is necessary for graduation during the current school year. The completed application and authorization form must be received by the public school in which the student is enrolled no later than Wednesday of the 18th week of the spring semester.

 

Envelopes should be addressed as follows:  Principal

                                                                          Attention:  Head Counselor

                                                                          Name and Address of School

                                                                          Zip Code