For consideration for the following school year, this form must be returned by: May 1, To: Sara Greenwood, LTC K12 Relations
Manager
REQUEST FOR
TRANSCRIPTED
COURSE
AGREEMENT
HIGH SCHOOL REQUEST FOR TRANSCRIPTED CREDIT CONSIDERATION DATE: __________________
To be completed by LTC Faculty (content area curriculum specialist) and returned to Sara Greenwood within two
weeks from the above date
High School:
_________________________________________________________________
High School Teacher Name
________________________________________________________________
High School Course Name __________________________________________________________________
Phone:
__________________________________
Email: ___________________________________________
LTC Course Title:
______________________________________________________________
Credits: _________
Course number:__________________________________________________
Course Length (check one)
Semester _________
Full year __________
Please circle
Y N High school teachers certification requirements are met and on file in LTC’s Human Resource Office in
accordance with TCS 3.03(9)(b) (A Master’s Degree with 18 credits in the discipline is required for
General Education courses. For program related courses a DPI license in a related field is required
along with any additional requirements set by external accrediting angencies.)
Y N The high school has the current competency-based curriculum materials for the course including tools
for student evaluation of the course at the high school OR will receive them from the LTC instructor by:
___________
Date
Y N The high school teacher agrees that the transcripted course will be taught following the LTC curriculum,
to include competencies, objectives, textbook (or approved alternative), assessment criteria and
conditions of the competencies, and grading policy
Y N The high school teacher is willing to discuss with the LTC instructor course related issues and
recommendations for improvements twice a year
Y N LTC faculty is able to verify that the high school has adequate classroom and other facilities needed for
the course are available
LTC FACULTY: TURN OVER TO INDICATE REQUEST APPROVAL OR DENIAL
Articulation Development Process (revised 9/5/13)
Page 1
REQUEST FOR
TRANSCRIPTED
COURSE
AGREEMENT
For consideration for the following school year, this form must be returned by: May 1, To: Sara Greenwood, LTC K12 Relations
Manager
Do you approve this request for Transcripted Course Agreement with LTC?
_______ Yes ________ No
If “NO” please provide an explanation:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
_________________________________________
________________
LTC FACULTY SIGNATURE
DATE
___________________________________________
LTC DEAN SIGNATURE
_________________
DATE
Articulation Development Process (revised 9/5/13)
Page 2