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Independent Study Contract 2017-18
This form is for all parents or students who intend to start an Independent Study Contract. Form must be submitted a minimum of two weeks BEFORE their scheduled absence. If you have any questions, please contact Ms. Potigian, or visit her in room 609.

Phone: (559) 978-5541

Email: ppotigian@mychawanakee.org

Email address
Student Name
Your answer
Student's School Email
Please enter a valid school email address
Your answer
In which school are you enrolled?
What grade level?
Parent/Guardian Name
Your answer
Parent/Guardian contact phone number
Please enter a valid phone number with the area code
Your answer
Contract Start Date
What is the first school day you will be missing?
MM
/
DD
/
YYYY
Contract End Date
MM
/
DD
/
YYYY
Will you have internet access?
Reason for requested absence:
Your answer
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