Appendix O

U-ACT Open Exit Request Form Form 1.0

Candidate Name_____________________________________________ Candidate Signature________________________________________ Date____________________________________________________________ Please indicate in one paragraph your reasons for requesting to exit early from the U-ACT program. Please indicate in your own words how you have met the competency requirements of the State. Also indicate the dates that you intend to complete the Teacher Performance Assessment. Your successful completion of this assessment is a requirement for completing the program.

Please submit this form to the U-ACT program director.