You are on page 1of 2

Alconbury Middle High School

REQUEST FOR SCHEDULE CHANGE


NAME

GRADE:

Class I would like to drop:


1.

PERIOD

Date:

Teacher Signature

2.
3.
Teacher comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Class you wish to drop and why (specific):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
-----------------------------------------------------------------------------------------------------------Class I would like to add:
PERIOD
Teacher Signature
1.
2.

__________________________________________________________

3.

______________

_____________

Teacher comments:
______________________________________________________________________________
______________________________________________________________________________
Class you wish to add and why (specific):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
STUDENT SIGNATURE:

DATE:

Parents agree with both dropped and added course: ___


Parents do not agree with both dropped and added course: __
PARENT SIGNATURE:

_____

___________________________
Mrs. Daniels- Principal

DATE:

___________

_______________________________
Mrs. Mitchell- Counselor

Principals and or Counselors comments:


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

You might also like