Independent Study Request
This request is the INITAL step in the Short Term (less than 15 school days) Independent Study approval process.  Please complete one for EACH child.  Short Term Independent Study is primarily intended for students who are on a COVID-19 related quarantine or isolation.

If your child has tested POSITIVE for COVID-19, please be sure to complete the Reporting Form here:  

https://docs.google.com/forms/d/e/1FAIpQLSetnCCCYqiI95S9CEAyaDnYNPJzFkwW0dL9ADrJRvH2xd3LPg/viewform

If this request is due to any other reason, the request requires 10-school days notice and may be denied.
Sign in to Google to save your progress. Learn more
Email *
STUDENT's Last Name *
STUDENT's First Name *
Student's GRADE for 22-23 SY *
Homebase Teacher or Room Number *
PARENT's Last Name *
PARENT's First Name *
PARENT's Contact Phone Number *
DURATION of Independent Study Request:  2 - 14 school days  *
DATES of Independent Study Request *
REASON for Independent Study Request:  2 - 14 school days  *
I understand this is only a REQUEST does not serve as an authorization to grant Independent Study at SJCA. *
Required
I understand I will have a scheduled meeting with a school representative in order to grant Independent Study at SJCA. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of San Jose Charter Academy. Report Abuse
Google Forms