School Procedures packet
2013-2014
Welcome All Students and Families to Delta/Greely Homeschool.
DGH has been redesigned to follow the correspondence format of
statewide programs that have been successful over the past decade.
It is our desire to have a program that meets the needs of all students
residing in the Delta/Greely Regional Education Attendance Area
who choose to home school.
Contained within this packet is much of the information that you
will need to understand how the program works, the procedures that
need to be followed and the important program requirements.
DGH is designed to allow for parent choice and flexibility as
allowed by the State of Alaska Correspondence Regulations.
The DGH program strives to be flexible enough to meet the needs
of our local population. To that end, to meet the ever changing
needs of our students, we encourage you to offer your opinions and
suggestions for improvement. We are here to serve you.
Sincerely,
Laural Jackson, Principal
Table of Contents
Contact Information……………………………………………….……………
Page 1
School Calendar………………………………………………………………...
2
Important Dates…………………………………………………………………
3
Program Requirements/Noncompliance………………………….……………..
5
Guidelines for Daily Instruction……………………………….……………….
6
Grading Scales…………………………………………………..………………
7
Examples of Monthly Contact…………………………………………………..
8
Religious Materials/Instruction………………………………………………....
9
Taking Classes at Other DGSD Schools………………………………………..
10
Graduation Requirements…………………….…………………………………
11
DGH computer program…………………………………………………….…..
12
Internet………………………………………………………………………….
13
The Allotment/Allowable Expenditures………………………………………..
14
Reimbursement Instructions…………………….……………………….….
15
Pre-Approval of Purchase Form………………………………………………
16
Reimbursement Form…………………………………………………………...
17
Purchase Requisition Form (for when you want the District to order the
materials………………………………………………………………………..
18
Special Instructor Packet………………………………………………………..
19
Contact Information
DGH Office
Parent Advisory Council
Contact Teacher Holly Stewart
895-1043 ext 28
hstewart@dgsd.us
The Parent Advisory Council is open
to parents/guardians of any student
enrolled in DGH. The council
strives to meet on a quarterly basis
as noted in the calendar of important
dates on page 3.
Secretary Char Lundy:
PO Box 369
Delta Junction, AK 99737
phone: 895-1043 ext 25
fax: 895-5198
clundy@dgsd.us
Principal Laural Jackson
895-4657 ext 24
ljackson@dgsd.us
DGH on-line
Facebook:
http://www.facebook.com/pages/
DeltaGreelyHomeschool/280657465279984
Website:
www.deltagreelyhomeschool.weebly.com
DGSD Counseling Website
http://huskycounseling.weebly.com/
1
Delta/Greely School District
July 4 Independence Day Holiday
Sept. 2: Labor Day Holiday
Sept 3: Staff Dev elopment
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9
16
23
30
JULY
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NOVEMBER
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SEPTEMBER
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10 11 12
17 18 19
24 25 26
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JANUARY
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14 15 16
21 22 23
28 29 30
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MARCH
W
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Nov . 11: Staff Dev elopment
Nov. 29-30: Thanksgiving Break
Dec: 23-Jan.3 Staff W inter Break
Jan. 6 Staff returns
January 17: Semester Grades Due
Jan 20: Staff Dev elopment
March 17-21: Staff Spring Break
March 31: Quarterly progress
reports due.
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13
20
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MAY
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May 1: Seniors grades due!
May 16: Graduation
May 26: Memorial Day
bookmark
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AUGUST
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13 14 15
20 21 22
27 28 29
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2013-2014
Aug 1: Staff returns from summer
F
2
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30
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Aug 13: Staff dev elopment day
F
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October 1-3HSGQE Retakes
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14
21
28
OCTOBER
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8
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15 16 17
22 23 24
29 30 31
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DECEMBER
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10 11 12
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FEBRUARY
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APRIL
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JUNE
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1
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2
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3
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4
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6
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7
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Oct. 31: 1st Quarter progress reports
Dec: 23-Jan. 3 Staff W inter Break
Feb. 17 Staff Dev elopment
April 1-4: State Assessments
June 3: 2nd Semester Grades due
June 3: All preorders for next
year's curriculum due.
2
IMPORTANT DATES FOR 2013-2014
Aug. 8 (1 PM & 7 PM) Paperwork and Packet party to review procedures and paperwork for the
program
August 16 (1:30 PM)
First Quarter Parent Advisory Council meeting (open to all parents)
August 28
School Pictures
Sept. 26
School Picture Retakes
October 18
Kindergarten Developmental Profile due
October 31
Mid-Semester 1 Progress Report and work samples due
Nov. 15 (1:30 PM)
Second Quarter Parent Advisory Council Meeting
Jan. 17, 2014
Semester 1 Grades and work samples due
Feb. 14 (1:30 PM)
Third Quarter Parent Advisory Council Meeting
March 7
Last day to add a course to an ILP
.
March 31
Mid-Semester 2 Progress Report and work samples due
May 1
Graduating seniors must have all work completed.
May 16
Graduation
May 23 (1:30 PM)
Final Parent Advisory Council meeting
June 3
Semester 2 Grades and work samples due
IMPORTANT TESTING DATES FOR 2013-2014
October 1-3
HSGQE Retakes (for 11th and 12th graders)
April 1-4
State Mandated Testing
SBA testing 3rd - 9th grade (Reading, Writing, Math)
HSGQE for 10th - 12th grade (plus adult retakes)
SBA (Science) for 4th, 8th, and 10th graders: (April 4)
3
IMPORTANT FINANCIAL DATES FOR 2013-2014
July 1,
Funds available for 2012-2013. Curriculum orders that are submitted
by June 3 will be ordered by the 8th.
January 31, 2014
Deadline to submit reimbursements for all expenditures July 1—Dec 31
April 18
Deadline for placing current year orders through the school district
May 15
Deadline for 2nd semester reimbursements with original receipts. Deadline to
encumber funds for May/June lessons.
June 3
Pre-orders for 2014-15 curriculum materials must be submitted in
order to assure they are ordered at the beginning of July.
June 15
Deadline to turn in your original receipts for May/June encumbered
funds to the school district office (Denise Coakley)
4
Program Requirements:
Monthly Contact: Contact should be initiated by the Home Educator (Parent) before the end
of every month. Please see the enclosed Monthly Contact document for more information on
what information is desired for monthly contacts. We might also ask you how many hours
your student has spent on each course, if additional resources or a home visit are desired, and
etc..
Progress Reports and Work Samples: There are four reporting deadlines during the school
year; specified on page 2, Important Dates for 2012-2013. Specific details are required in the
Progress Reports for each course listed on the ILP; the details needed are determined by the
Contact Teacher and Home Educator. A work sample is also required for each course listed
on the ILP. Work samples are agreed to by the Contact Teacher and Home Educator.
State Testing: All 3rd - 12th grade students are required to participate in standardized testing.
This includes: developmental profiles, SBAs, Terra Novas, WorkKeys, and HSGQEs. It may
also include the ACCESS test if your student is an English Language Learner.
Non-Compliance Course of Action:
A family will be considered Non-Compliant if they do not maintain monthly contact or
submit a Progress Report and Work Samples on time.
1st warning: Home Educator will be contacted with details about what they need to submit,
and by when, to become compliant. Family accounts will be ‘on hold’ until documents have
been received.
2nd warning: Home Educator will be contacted by certified letter about what they need to
submit, and by when, to become compliant. Family accounts will be ‘on hold’ until
documents have been received.
3rd warning: DGH will withdraw any student whose documents do not show adequate
progress. Accounts will be closed.
Students who do not participate in state testing will placed on “probation” until the
following year’s testing is complete. This means family accounts will only be allowed to be
used for curriculum until the next year’s testing is complete.
(Reimbursements will be held until after the testing has been completed.)
5
Guidelines for Daily Instructional Time
Average Minutes per Day
Subject
Grades
K-3
Grades
4-6
Grades
7 - 12
Language Arts: Grammar, Literature, Spelling,
Reading, Writing, Speech
120
135
135
Math
45
55
60
Science/Health
25
35
50
Social Studies
25
35
50
Physical Education
20
25
30
Music/Art/Technology
15
30
35
4 hours
5 h 15 m
6 hours
Total
Some days might take longer to cover a topic, some days
might be shorter, some weeks might have to spill over into the
weekend...that’s homeschooling.
The important thing is that your child is getting the best
education possible...however long that takes.
It’s not enough to be busy, so are the ants. The question is, what
are we busy about?
Henry David Thoreau
6
Grading Scales
For grades K-3 please use the following grading scale:
Letter Grade
Percentage
Meaning
E
90 - 100
Excellent
P
70 - 89
Proficient
N
0 - 69
Not proficient
For grades 4 - 12 please use the following grading scale:
Letter Grade
Percentage
GPA pts/credit
A
93 - 100
4.0
A-
90 - 92
3.7
B+
87 - 89
3.3
B
83 - 86
3.0
B-
80 - 82
2.7
C+
77 - 79
2.3
C
73 - 76
2.0
C-
70 - 72
1.7
D+
67 - 69
1.3
D
63 - 66
1.0
D-
60 - 62
0.7
F
0 - 59
0.0
INCOMPLETE CLASSES;
DGSD AR #5121: A grade of “Incomplete” may be issued by a teacher when the student has not completed the
requirements for the course. Incompletes must be made up within ten (10) school days of the end of the grading period.
Any incomplete not changed by the end of the ten (10) days automatically becomes and “F” unless there are extenuating
circumstances approved in advance by the building principal. During the time an incomplete is on a report card, it will
be treated as an “F” in so far as eligibility for extracurricular activities is concerned.
For DGH purposes a grade of “Incomplete” will be entered for all classes for which we do not have grades from the
parents by the grade submittal date. If the grades are not submitted within the 10 day timeline, the grade will revert to an
“F”.
7
Monthly Contact Example
Here is an example of an e-mail from one Home Educator (names have been
changed):
Oct. 8th
Randy: He is almost finished with his first quarter of math. He has been having problems
with his 3 digit multiplication so we have been doing extra work on that. He knows his
facts, but makes silly mistakes such as carries the number in the wrong place value spot.
He just finished his first unit on poetry and did very well. The kids had to plan a coffee
house reading. (setting, menu, drinks, backdrop and poems) He began writing poems on
his own. Spelling is going well, half way through level. Science and Social....Just finished
the 50 states and now beginning a year long ocean study. We will begin a ww2 study in the
coming weeks.
Sam: He finished his first quarter of math. He is doing very well. Spelling is also
going very well. In Lang. Arts he also did the coffee house read. Performed well and was
very clever with his poems. He defiantly has the creepy, goofy personality. lol He also
learned about the 50 states and will begin the ocean and ww2 studies.
Jennifer: She finished her first quarter of math. Did very well. Learning lots of geometry
now and doing well. She is still on lesson 45/120 in spelling. SHe is doing great on her
spelling test though. Again, Jenni performed in the coffee house read and spoke very clear
and was not nervous. (she has a hard time with public speaking) Her poems were well
written. She is excited to learn about the oceans and ww2.
Marlee: She finished her first unit in lang. arts. She planned a frontier dinner for her
family. She studied the Little House on the Prairie. Her spelling and math are going
very well. She too finished the first quarter. She is eager to learn her multiplication facts
so she is doing additional work on those. She has begun cursive writing as well. She
joined the older kids with the 50 states and will begin the ocean studies. She is very excited
for that.
Mark: He had a slow start to school. It took him up until last week to get in the groove.
His spelling is now doing better; he had a rough start on review. His math; we tested him
into it and he got to skip the first 30 lessons. On writing he has done very well. He has
already written 3 papers (a paragraph each). He even wrote a letter to a soldier in
Afghanistan. We will update you on that!
8
Religious Curriculum Materials
Per state regulations, public schools may not purchase any faith-based
curriculum or products. Also, faith-based courses may not be used to
determine a student’s full-time status. This means that at least four courses
need to be able to be paid for by DGH for the student to be considered fulltime and eligible for a full allotment; courses using faith-based curriculum are
not allowed to be counted towards the four courses.
However, parents are still allowed to use and purchase faith-based curriculum
themselves. Credit can be designated for these courses as long as they meet
the same requirements as nonsectarian courses (reviewed by the Contact
Teacher, are included in the ILP, and Progress Reports and Work Samples are
received.) These courses will be noted on the transcript outside of the DGH
program.
Example of acceptable ILP, noting faith-based courses:
Language Arts - Abeka
Math - Saxon
Science - Abeka
Social Studies - Abeka
Physical Education - PDC
Spanish- Rosetta Stone
Art - Artelier
Taking classes in other DGSD Schools
Students are able to take classes from other Delta/Greely Schools. For
example a student enrolled in Delta/Greely Homeschool may take classes at
Delta High School. The courses will each cost $150/semester from the
student allotment and students are expected to meet the same attendance and
course work requirements as other students in the class.
Students who are enrolled in other DGSD Schools are under the supervisory
responsibility of the school only during the times of their assigned classes and
may not remain at the school beyond those classes unless other
accommodations have been made with the site principal. It is the DGH
student/family’s responsibility to provide transportation to/from the courses;
however DGH students are allowed to use the District bus service when that
coincides with the start/finish of their classes.
9
Delta/Greely Homeschool Graduation Requirements
Class of 2016
Student: ________________________________DOB:_____________
Phone: H:____________
C:______________
Mom:__________________________Dad:_____________________
Language Arts: 4 Credits
Grade
*English I (1 credit) English I, 1st semester
English I, 2nd semester
*English II (1 Credit) English II, 1st semester
English II, 2nd semester
_______
_______
_______
_______
English Elective (1/2) ______________________________
English Elective (1/2)_______________________________
English Elective (1/2) ______________________________
English Elective (1/2)_______________________________
_______
_______
_______
_______
Mathematics: 3 Credits
Grade
*Algebra (1 Credit)
Algebra, 1 semester (1/2)_______________
Algebra, 2nd semester (1/2)_______________
Math Elective (1/2)______________________
Math Elective (1/2)______________________
Math Elective (1/2)______________________
Math Elective (1/2)______________________
st
Science: 3 Credits
*Biology (1 Credit)
________
________
________
________
________
________
Grade
Biology, 1st semester___________________
Biology, 2nd semester__________________
Science Elective (1/2)__________________
Science Elective (1/2)__________________
Science Elective (1/2)__________________
Science Elective (1/2)__________________
_______
_______
_______
_______
_______
_______
Social Studies: 4 Credits
Grade
*US History (1 Credit)US History, 1st semester (1/2)____________
US History, 2nd semester (1/2)____________
*AK Studies (1/2 Credit)AK Studies (1/2) _____________________
SS Elective (1/2)_______________________
SS Elective (1/2)_______________________
SS Elective (1/2)_______________________
SS Elective (1/2)_______________________
SS Elective (1/2)_______________________
_______
_______
_______
_______
_______
_______
_______
_______
10
Physical Education/ Health: 1 Credits
PE/ Health (1/2)______________________
PE/Health (1/2)______________________
Fine Arts or Foreign Language: 1 Credit
FA/FL Elective (1/2)___________________
FA/FL Elective (1/2)___________________
Electives: 6 Credits
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Elective (1/2)_________________________
Total Credits:
Grade
_______
_______
Grade
_______
_______
Grade
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
22
*Required Courses
11
DGH Computer Program
Pre-requisites to be eligible to participate in the DGH Computer Program:
¨ There must be at least one student enrolled full-time through the month of October.
¨ One computer option is available for families with 1 - 3 students; two computer options are
available if there are 4 or more students.
-The computer programs are only available through March of each academic year
Computer Purchase-Reimbursement Program
This computer purchase program is designed for families wanting to have specific computer
options to match their particular educational needs. The family can purchase a computer of
their choice and receive three reimbursements per year to help pay for the cost of the
computer. Forty dollars ($40) per month will be reimbursed from the purchase date based on
the following payment schedule until full reimbursement level is reached:
o 1st Reimbursement (July-November): November 30th
o 2nd Reimbursement: (December-February): February 28th
o 3rd Reimbursement (March-June): April 30th






Original receipt for computer is required
Payments will begin after full time enrollment is verified in November
Payment will continue upon receipt of quarterly reports and work samples
Month of purchase will determine payment start date.
This reimbursement does not come from the student allotment
For eligible students who re-enroll, payments will continue automatically the
following November.
One Time $199 Reimbursement Program
Families may choose to purchase a computer and receive a one-time reimbursement of up to
$199 for the cost. This reimbursement does not come from the student’s account.
Preapproval is required and reimbursement will not occur until after the student has been
enrolled for the entire student count period in October.
Computer Assistance Program
DGSD has some good used computers that will be loaned to families in need. These
computers are available on a first come first served basis and may be limited in number.




Available for students enrolled full time through the October count date.
$50 user fee/year is responsibility of family
One computer per every 3 students
Computer will be relinquished to the family after two years of enrollment with the
program
 Family is responsible for maintenance of the computer
12
Internet Stipend
Delta/Greely Homeschool will reimburse families for access to the internet. The family must
have at least one student enrolled full-time in the DGH program through the month of October
each academic year. The stipend allowable is not to exceed $10.00 per student per month.
Original receipts or documentation is required for reimbursement.
Internet charges must be clearly marked upon the receipt for eligibility. Receipts showing
“bundled” services will be reimbursed for internet access only. Charges for usage fees and
modem rental will be deducted from the reimbursed amount. Credits provided for cable, long
distance fees and taxes will be excluded when determining the amount to be reimbursed.
These expenses are considered personal and /or entertainment and are prohibited by
regulation.
This stipend is provided outside of the student allotment. Note: The reimbursement form and
receipts for May internet services must be received by June 15th. June internet may be
reimbursed in July for students who re-enroll.
13
THE ALLOTMENT/ALLOWABLE EXPENDITURES
Grades K-3: $1700
Grades 4-8: $1900
Grades 9-12: $2100
There is a $75bonus added to the allocation for families who enroll prior to May 15, 2013.
As per regulation 4 AAC 33.421 (k), a statewide correspondence study program may not pay
for or provide money for:
(1) family travel, including transportation, food, or lodging; or for expenses during, or for any
out of state travel unless a governing body or superintendent of the district approves expenses
incurred in the out-of-state travel that are associated with direct instructional activities; in this
paragraph, “family travel” does not include travel in which a student is accompanied by the
student’s family for assessments or other required activities initiated by the district;
(2) annual passes or family memberships to a sports or recreational facility; however, an
annual pass or membership for the student may be purchased for entry into sports or
recreational facility in which the student is provided lessons under the student’s
Individual Learning Plan, if the cost of the pass or membership is prorated to include only the
cost of the student’s instructional time;
(3) fees that allow entrance to a facility in which no instruction directly connected to a
student’s Individual Learning Plan under (e)(1) of this section is given;
(4) religious, partisan, sectarian, or denominational textbooks or other curriculum materials;
(5) services provided to a student by a family member; in this paragraph, “family member”
means the student’s spouse, guardian, parent, step-parent, sibling, step-sibling, grandparent,
step-grandparent, child, uncle, or aunt;
(6) clothing, uniforms, physical education equipment, or personal items;
(7) pets and other animals;( no “animals or related equipment” ie. bees, eggs that will grow
into animals, reptiles or insects, ant farms, etc. will be allowed.)
(8) furniture;
(9) taxes, testing other than educational assessments required by the district, or parking fees;
(10) entertainment;
(11) permanent items that adhere to or enhance the value of a non-school facility; or
(12) items that are considered excessive by the school administrator.
As per 4 AAC 33.422. (b): Textbooks, equipment, and other curriculum materials purchased
with state money, including money provided to the parent through a fund account, are
property of the district. Materials that are not consumables must be returned to the district
when the student leaves the program for any reason. DGH considers curriculum materials
from $199.99 or under to be consumable and not subject to return after the student is finished
with the material Equipment which is purchased and costs less than $199.99 is depreciated
over three years after which time it will be relinquished to the family. Should the family
leave the program prior to three years time, the equipment is expected to be returned to the
District. Any item purchased by the district over $199.99 must be returned after the student
leaves the program. Items returned are placed in the parent resource room or placed on the
District surplus item list for sale to general public.
14
Reimbursement Instructions


Please submit receipts periodically throughout the year to ensure your
reimbursements are processed in a timely manner.
 All items purchased or reimbursed for your student must have an educational purpose
related to their ILP. Purchases must be reasonable and reflect student goals.
 If you have a questionable purchase please submit a Pre-Approval form to your
Contact Teacher (prior to purchasing).
 Delta/Greely Homeschool reserves the right to deny any purchase if it violates district,
state, or federal policy, rules or regulations.
Excessive spending at the end of the school year will be denied.
Requirements for completing the Reimbursement Form:
¨ Number your receipts please
¨ Date - please write in mm-dd-yy format, date must appear on the receipt
¨ Student Name—who the purchase was for
¨ Vendor Name must appear on the receipt
¨ Description of product, service, etc.
¨ Course—which class did the purchase relate to
¨ Educational Purpose—what purpose did the purchase serve
¨ Total Cost must appear on the receipt (DO NOT include sales tax)
¨ Total Amount—total of all receipts in the Total Cost column
¨ Attach all receipts and submit to your DGH teacher for approval
Some bookkeeping how-to’s:
· Attach original receipts to an 8 1/2” x 11” sheet of notebook or printer paper.
· Write your family name and number on the top of the sheet.
· Keep all receipts in the same direction.
· Do not use highlighters on receipts and do not write over any printing on the receipt
· Next to the receipt please write which line on the Reimbursement Form it corresponds to.
· Next to the receipt please write what the purchase was for if it not already obvious.
· If the receipt just lists ‘book’ you will need to write the title of the book next to the receipt.
· On the receipt, the business office needs to be able to see the vendor, date, description and
price of each item, total amount paid, method of payment, and any tracking information as
proof of your purchase.
Unacceptable “receipts”:
· Xerox/faxed/scanned/emailed receipts
· A statement with a Balance Due
· Carbon copies or bank copies of checks
· Price tags
 Receipts with dates prior to enrollment or after withdrawal.
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Pre-Approval for Reimbursement
· All purchases must be appropriate expenditures of public funds as per DGH Parent Student Handbook.
· All expenditures must be directly related to student’s ILP.
· This form must be submitted PRIOR to purchases.
· Letter of alignment and request must be submitted with this form for out of state expenditures.
Family Name:_____________________________
Date
Student’s Name
Name of
Vendor
Phone # _____________________
Teacher: _____________________
Descriptions of
Equip./Materials/Service
Course
Cost
Approved
Amount
Explain the Educational Purpose and Justification:
Parent Signature: __________________________
Administrator Signature: _____________________________
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Teacher Signature: _________________________
Date received at DGH: ______________________________
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Family # ____________
REIMBURSEMENT FORM
Family Name:
Phone:_____________________
Date:
Teacher:____________________
*Items must relate to each student’s ILP and be approved by Advisory Teacher to be processed.* Individual receipts not taped to an 8 1/2”x11” paper may cause a delay in
processing.
# of
Receipt
Date
Student
Name
Vendor Name
Description of
Purchase/ Service
Course
Educational Purpose
(Supplies, Curriculum,
Instruction)
Total
Cost
1
2
3
4
5
6
7
8
9
10
Total
Parent Teacher Signature: ________________________________________________
Advisory Teacher Signature: ______________________________________________
Principal Signature: ____________________________________________________
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Special Instructor’s (Lessons for Music, Art, etc)
Delta/Greely Homeschool families are able to contract for lessons included in their ILP for such things
as art, music, dance and physical education. The families have a choice to either pay for the lessons
and get reimbursed by the district or to have the instructor bill the lessons to the District.
If the District is paying the provider directly, we require additional including paperwork for liabaility,
tax and billing purposes. Just work with Char to let her know you want this set up. The cost of a
background check will be deducted from the first payment. Generally the cost runs from $10 to $50
depending on how often you have moved.
Please keep in mind that for students in grades 7-12, lessons which constitute a grade on the student’s
report card for fine arts do require that a Highly Qualified Certified teacher of that subject area oversee
the planning and grading of the program. DGSD will provide this oversight as part of the DGH
program.
Thank you.
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Special Instructors Information Form
Business Name: ___________________________________________________
Contact Person: ___________________________________________________
Address: ________________________________________________________
_______________________________________________________________
Phone Number: ___________________________________________________
Fax Number: _____________________________________________________
E Mail: _________________________________________________________
Subjects Taught: _________________________________________________
Are you an Alaska Certified teacher: Yes No
Please include a copy of your resume, brochure, or other documentation of your
qualifications, along with any details that would assist in our approval process.
Attached _____
Already on file _____
I understand that I will be paid by the family who will be reimbursed based on the invoices
for lessons provided unless I have made arrangements to be paid directly through the District.
Be sure to contact the DGH office so that necessary paperwork is completed.
Rate Scale:
Per Lesson
Per Month
Per Week
Per Session
Individual Instruction
$_________________
$_________________
$_________________
$_________________
Group Instruction
$_________________
$_________________
$_________________
$_________________
Please read and sign:
 I understand clearly that the family, not the District, is retaining your services
 The DGH Reimbursement Form is required in order for payment to be rendered either to
the parent or to you.
 Payments or reimbursements will not be made by DGH until after the services are
rendered. The District will not pay for any missed lessons.
 Payments will not be made in excess of the rate stated in this agreement. Any excess
amount incurred is the responsibility of the family.
 DGH is prohibited from paying sale tax.
 If there is any disparity between what you bill and what we pay, this difference is the
family’s responsibility and must be resolved between you and them.
Instructor Signature: ___________________________
Date: _____________
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