Acknowledgement Forms

Employer Acknowledgement Form

Employer Notification of Student Acceptance into Hoosier Academies Network of Schools Flex
Instruction Program

I, __________________ ,understand that Hoosier Academies Network of School student,

________________ has been accepted into the Flex Instruction Program and must meet the

expectations of the Hoosier Academy FLEX program. I understand that I am responsible for completely

monthly reviews of __________, and if the student does not maintain the requirements, they will no

longer be able to participate in this program.

FLEX Program Requirements:

 Must be in 11th or 12th grade
 Attend school for at least three hours of instructional time per school day (enrolled in 3 classes
minimum).
 Maintain a 95% attendance rate.
 Maintain passing grades in all subjects at Hoosier Academies High School.
 Not be suspended or expelled while participating in the school flex program.
 Pursue course and credit requirements for at least a general diploma.
 Pursue a timely graduation.
 Provide proof of employment or college enrollment Provide current pay stub from employer or
letter from employer or college course schedule
 Provide employer contact number to school personnel in the case of an emergency.

Employer Contact Information

Employer Name Employer Contact Name & Title Employer Contact #

* Please notify Hoosier Academies High School in the case of termination.

Hoosier Academies reserves the right to random verify employment at any point in the semester.

2855 N. Franklin Road | Indianapolis, Indiana 46219 | (p) 317.495.6494 | (f) 317.498.6020
 Acknowledgement Forms

Student Acknowledgement Form

By signing and returning this letter, you are acknowledging that you have read and understand the
expectations of the Flex Program.

___________________________________ ___________________________________

Student Name Student Signature

___________________________________ ___________________________________

Legal Guardian Name Legal Guardian Signature

___________________________________ ___________________________________

Flex Program Lead Counselor Name Flex Program Lead Counselor Signature

___________________________________

Date of review and discussion

2855 N. Franklin Road | Indianapolis, Indiana 46219 | (p) 317.495.6494 | (f) 317.498.6020
 Acknowledgement Forms

Include copy of most recent pay stub

Include copy of monthly work schedule

2855 N. Franklin Road | Indianapolis, Indiana 46219 | (p) 317.495.6494 | (f) 317.498.6020
 Acknowledgement Forms

Date:

Dear_______

Congratulations! You have met all of the requirements to participate in the School Flex Instruction
Program. Being part of this program provides you with wonderful opportunities to learn how to
manage your time, stay focused, and learn real world experiences.

Being part of this program is an honor, and to ensure that you are maintaining the program
expectations as well as the school’s expectations, you agree to the following:

● Maintain all the prerequisite requirements;

● Participate in statewide testing;
● Attend whole group and small group lessons;
● Pass all of your classes;
● Attend monthly meetings with the assigned counselor;
● Complete monthly self -reflections; and
● Maintain communication with teachers, counselor, and administration.

Before you officially begin the program, please attend our Review of Student Expectations meeting on
___________ at, _______________ to ensure a positive experience.

I am looking forward to our meeting. Please be sure to have this letter ready to upload for our records,
along with the attached form that must be completed by your employer, copy of your most recent pay
stub, and monthly work schedule.

Sincerely,

2855 N. Franklin Road | Indianapolis, Indiana 46219 | (p) 317.495.6494 | (f) 317.498.6020