SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

OFF-CAMPUS AGENCY AGREEMENT

To Be Completed by Agency Instructor

Agency Responsibilities

1. The agency must read these responsibilities and complete the information on the following page.

2. The agency must provide professional instructors who will teach required lessons and provide necessary supervision.

3. The instructor will:

· Sign applications and fill in activity schedules for students participating in the Off-Campus Program at the instructor's agency.

· Sign an Instructor Agreement stating that he/she is aware of the emphasis on program objectives and grading based on performance and attendance.

· Maintain an accurate record of student attendance. Evaluate each off-campus student's performance and submit a grade recommendation for each student, based on performance and attendance, at the end of each grading period. The grade report must be faxed to the school office no later than the Tuesday following the end of a grading period.

· Inform the administration if a student's attendance becomes irregular.

Please note the following requirements:

· The required hours each week must be spread over at least three days and include at least ninety minutes of instruction by an approved instructor.

· At least five of the required hours each week must be completed Monday through Friday.

· A maximum of two hours each week may be completed for competitive meets/tournaments.

· The student may not have more than five unexcused absences per semester.

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