Rev. 11/2018 PASS Course Preview Request Form B-1

Washington State PASS Program Migrant Student Data, Recruitment and Support 810-B East Custer Avenue | Sunnyside, WA 98944 Phone: (509) 837-2712 or (800) 274-6084 | Email: pass@msdr.org | Fax: (509) 839-9017 | Website: www.msdr.org

THANK YOU FOR YOUR INTEREST IN PASS!

Submit this form to request a 30-day preview of a PASS course. The shipment will include student workbooks for units 1, 2, and 5, and unit one text book (if applicable) so that you may determine whether the course is right for your student. To enroll a student and receive the balance of course materials, sign up as a Contact Person, submit Form A available at www.msdr.org. Login to the PASS Database and complete the online enrollment indicating that you received a course preview. If you will not be enrolling a student within 30 days, please return the previewed materials promptly to avoid being invoiced. See Course List and Cost for latest fees.

SECTION 1: DISTRICT/AGENCY INFORMATION

Ship materials to (Organization and Name of Person):

District/Agency Name: Phone Number: (_____)

Building Name (if different than above District/Agency):

Street address (UPS will not deliver to P.O. Box):

Would you like a PASS Success Handbook and Course Descriptions Manual? ❑ YES ❑ NO

I certify that the PASS materials requested below will be used for preview purposes only. If I do not wish to order the full course(s), I will return the preview copies at my expense to PASS within 30 days. I understand that I will be billed the purchase price of each course if materials are not received at PASS within forty-five days from shipping to me.

____________________________________________________________________________ Signature Date

Check the name of the course(s) you would like to preview. Courses identified with an (MS) are available to 7th and 8th grade students when enrolling middle school has collaborated with the local high school to accept PASS high school credit for these courses. See Success Handbook for more information. Elective courses identified with an * may be used to satisfy other requirements at school counselor’s option.

COURSE OFFERINGS:

English Courses ❑ English 1A ❑ English 1B ❑ English 2A ❑ English 2B ❑ English 3A ❑ English 3B ❑ English 4A ❑ English 4B ❑ Creative Writing ❑ Four Ps: Plan, Pathway, Portfolio & Project ❑ Preparing for College ❑ Learning English Through Literature

Social Studies Courses ❑ Contemporary World Problems ❑ Economics ❑ U.S. Government ❑ U.S. Government - Spanish ❑ U.S. History A ❑ U.S. History A – Spanish ❑ U.S. History A – Russian ❑ U.S. History B ❑ U.S. History B – Spanish ❑ Washington State History and Government (MS) ❑ Washington State History and Government – Spanish (MS) ❑ World Geography ❑ World Geography – Spanish ❑ World History A ❑ World History B

Mathematic Courses ❑ Algebra 1A ❑ Algebra 1A – Spanish ❑ Algebra 1B ❑ Algebra 1B – Spanish ❑ Algebra 2A ❑ Algebra 2A – Spanish ❑ Algebra 2B ❑ Algebra 2B – Spanish ❑ Geometry A ❑ Geometry B

*Elective Courses Study Skills ❑ Preparing for College General Math A (MS) ❑ General Math B (MS) Pre-Algebra (MS) ❑ Pre-Algebra – Spanish (MS) Consumer Math (MS) ❑ Consumer Math – Spanish (MS) Math 8A (MS) ❑ Math 8B (MS) Civic Involvement CBA

Science Courses ❑ Biology A ❑ Biology B ❑ Environmental Science A ❑ Environmental Science B

Health Courses Due to course content, permission to enroll in Health must be on file locally.

❑ Health and Fitness ❑ Health and Fitness – Spanish

Art Courses ❑ Visual Arts A ❑ Visual Arts B

High School & Beyond Plan/Culminating Project Course ❑ Four Ps: Plan, Pathway, Portfolio & Project

Course materials are protected by copyright laws and subject to a reservation of rights by U.S. Department of Education and Superintendent of Public Instruction. PASS course materials may not be reproduced in full or in part without the express written consent of the PASS Program. Additional details may be found in the individual course.

FOR OFFICIAL USE ❑ Approved, send course Date shipped: Packaged by: Returned date: ❑ Do not invoice Invoice #: Amount: $: Invoice date: