Mazama High School SCHEDULE CHANGE REQUEST ________________________________________________ __________ __________________ Last Name, First Name

Grade

Current Schedule ___ Sem 1 ___ Sem 2 Per

Drop Course

Teacher Signature

0 1 2 3 4 5 6 7

Date of Request

Requested Schedule ___ Sem 1 ___ Sem 2 Per

Add Course

Teacher Signature

0 1 2 3 4 5 6 7

_________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Reason for schedule change request:

Filling out this form and obtaining the new teacher’s approval does NOT guarantee a schedule change. STUDENT & PARENT/GUARDIAN AGREEMENT:      

I understand that I must continue to attend my original classes until this request has been approved or denied. If this request is approved, I will be given a new schedule from the Counseling Office. I am responsible for my attendance and all work until I receive a new schedule. If this request is denied, I understand that I will be required to stay in my original classes and; therefore, I must attend all scheduled classes, participate, and complete all assignments. I understand that my signature does NOT guarantee the schedule change will be approved. I reviewed page 4 of the Mazama High School Curriculum Guide for policies regarding schedule changes. I acknowledge, by my signature, that I have read and understand the above information.

__________________________________________

_________________________

Student Signature

Date

__________________________________________

_________________________

Parent/Guardian Signature

Date

COUNSELING OFFICE RESPONSE: Enrolled in all courses necessary for gradation? ____________ Comment:

_________________________________________________________________________

Approved: ____

Denied: ____

__________________________________________

_________________________

Counselor Signature

Date

__________________________________________

_________________________

Curriculum Director Signature

Date