High School District 155 -- Level Change Request for 2017 School Year Step 1: Please fill out the following information ________________________________ Full Student Name

________________ is requesting a change in level from ________ to __________. Student ID # Course # Course #

Step 2: Request initiated by: ____ Student

______ Parent

______ Teacher

_____Counselor _____Division Leader

Date request initiated: __________________ Primary reason(s) for initiating request: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Step 3: Follow the directions for the column that meets your request. If you are requesting to move up If you are requesting to move up If you are requesting to or down a level in Math or or down a level in Social move up or down a level in English, then please provide Sciences, then please provide the Science, then please provide the information below: information below: the information below: Last semester English grade: ______ or Current English grade: ______ Counselor’s initials: ______

Last semester S.S. grade: _______ or Current S.S. grade: ______ and Last semester English grade: _____ or Current English grade: ______

Last semester math grade: ______ or Current math grade: _____ Last semester science grade: ______ or Current science grade: _____

Counselor’s initials: ______

Counselor’s initials: ______

Step 4: In the following order, please request the following recommendations and signatures. 1. Current Teacher ______ Recommend _____ Not Recommend _____________________________ Signature 2. Division Leader ______ Recommend _____ Not Recommend _____________________________ Signature 3. Parent ______ Recommend _____ Not Recommend _____________________________ Signature 4. Counselor ______ Recommend _____ Not Recommend _____________________________ Signature

If you are requesting to move up or down a level in a World Language, then please provide the information below: Last semester World Language grade: ______ or Current World Language grade: _____ Counselor’s initials: ______

________________ Date ________________ Date ________________ Date ________________ Date

Step 5: If moving up a level and all participants have checked “recommend,” then submit the completed form to the counselor for final preparations. If the request is for the upcoming school year, then students have the last ten days before the end of the school year to complete the process for moving up a level. If the request is for the current school year, then students have until the end of the day before the beginning of the 2nd or 4th quarter to complete the process for moving up a level. If moving down a level and all participants checked “recommend,” then submit the completed form to the counselor for final preparations. Students have until the day before the end of the 1st or 3rd quarter to complete the process for moving down a level. If someone has checked “not recommend,” yet you still want to proceed then please meet with your counselor to familiarize yourself with the final steps in the process. Whether moving up or down a level, the grade earned at the time of the transfer will carry over to the new course level (e.g., conversions in grade weighting will not occur).