Schedule Change Request Form


Schedule Change Request Form
This is the method to request a schedule change effective the first day of school
This form must be completed and returned to the Student Services Office
Name ____________________________________________
ID # _____________________________
Reason for Request-Check one below and complete information where requested.
_____ Increase Rigor
Current Class: __________________ Requested Class: ____________________
_____Previously failed teacher for same course: Teacher Name:________________________________
_____Scheduled for course previously passed:
Course Name: _________________________________
_____ Missing a course needed to graduate this year:
Course Name: ___________________________
_____ Incomplete Schedule (Hole in Schedule): Missing Period: ______
_____ Scheduled for Same Course Twice: Course Name: ______________________________________
_____ Sequencing Issue (Level 2 before Level 1): Course Names: ________________________________
_____ Attended LRHS last year and now enrolled in a class that was not selected.
(Registration Documents and Courses entered into PowerSchool by student will be reviewed):
Course Names: __________________________________________________________________
 One of the above reasons must be checked for your request to be considered. No changes are
guaranteed, even if a teacher has agreed to a change or tells you they have room in their class.
 If the schedule change is approved, a new schedule will be given to the student by their first
period teacher.
 If the schedule change is denied, this form will be returned to the student by their first period
 If the counselor needs to speak with a student about their request, they will be called out of
Comment from student:
Please Sign Below and Return to Student Services
Student Signature: _____________________________________
Date: _______________________
Parent Signature: ______________________________________
Date: _______________________
Student Services Use Only
_____ Approved-New Schedule Sent to Student Date: _____________________
_____ Denied-Denial Sent to Student
Date: __________________
Reason: ______________________________________________________________________________


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Parent category: Business