Schedule Change Request Form printable pdf download

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

teacher.

 If the counselor needs to speak with a student about their request, they will be called out of

class.

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: ______________________________________________________________________________

_____________________________________________________________________________________

Schedule Change Request Form