Provincial EXC 12 Credit Program Coordinator

This application form is to be completed by the guidance counsellor of all FSL students interested in the Expérience culturelle12 credit, following the guidelines and procedures presented in this document: New French Second Language Programs Grade 12 Credit -Expérience culturelle 12 (EXC12)-Administrative Information for Schools.

Please attach a letter written by the student indicating why he or she is applying to obtain the credit.

Please forward all required documents postmarked no later than April 15 to:

Nova Scotia Department of Education and Early Childhood Development

Provincial EXC 12 Credit Program Coordinator

Brunswick Place

2021 Brunswick Street

PO Box 578

Halifax, NS B3J2S9

Or email to:

To becompleted by the guidance counsellor:

1. Name of student :
2. Gender : ChooseMaleFemaleTrans MaleTrans Female
3. Age : Choose141516171819
4. Date of birth :
5. Grade : Choose9101112
6. Contact information of student:

Phone Email:

Address:

1. Current school year: Choose2013-20142014-20152015-20162016-20172017-20182018-20192019-2020
2. French Second Language Program in which the student is enrolled: ChooseFrench ImmersionIntegrated FrenchCore FrenchNot a FSL student
3. French Cultural Program selected: ChooseNova Scotia/Québec Student Exchange ProgramExplore Program
4. Does the student require this credit to receive his or her French Immersion certificate?

Yes No

1. Does the student require this credit to receive his or her Integrated French certificate?

Yes No

1. Does the student require this credit because there is no Core French class available for him or her this year? Yes No
2. Does the student require this credit to receive his or her High School Diploma?

Yes No

1. Is there any other reason why this student may require this credit?
2. Has the student been made aware of the following requirements for receiving the credit:
3. The studenthas applied for the NS/Québec Student Exchange or Explore program before the deadline of April 10. Yes No
4. The student understands the rules and expectations of the Program and agrees to adhere to them.

Yes No

1. The student keeps a French daily journal (or French reflection paper for Explore students) and a detailed French portfolio, following the established guidelines. Yes No
2. The student in the NS/Québec Student Exchange Program participates in two French oral interviews, one before and one after the exchange. Yes No

1. Name of Guidance counsellor:
2. Contact information of guidance counsellor:

Phone Email:

16. Name of school and school board:

17. Date of completion of this form:

18. Please add any other pertinent information that may support this student’s application for

the credit:

For further information:

Visit the following website:

Or contact:

Jean-Claude Bergeron

Provincial EXC 12 Credit Program Coordinator

French Second Language Program Services

Nova Scotia Department of Education and Early Childhood Development

Phone: (902) 424-4499

E-mail: