11th and 12th Grade 340 Request Form
WISCONSIN ACT 340 PRIVILEGE REQUEST FORM

Under Wisconsin Act 340, high school pupils who demonstrate a high level of maturity and personal responsibility may leave the school premises for up to one class period each day if the pupil does not have a class scheduled during that class period.

The student named below is requesting permission to be released from school for one class period each day under Wisconsin Act 340. Student understands that this is a request for a privilege and is not a guaranteed right. This privilege will be approved, denied or revoked at any time based on attendance (this includes tardiness), grades (students earning a D or F for any reason) and/or school/classroom behavior.

It is also understood that for this privilege to be granted the student must receive positive support from teachers, Student Services and the administration.

NOTE: This request should be made prior to school starting, if the student would like to be approved within the first week of school. Please complete this form during or after registration, once the Commons or Study Hall hour has been verified. Semester changes need to be verbally given to the Student Services Office.

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Grade *
Parent Name, First and Last *
Your answer
IF STUDENT HAS MORE THAN ONE Commons, Study Hall, or Resource in schedule, please list student's preferred hour for 340. NOTE: Student may ONLY request a 340 during ONE existing Commons, Study Hall, or Resource period. *
Required
I give my student permission to leave the school premises during their Commons, Study Hall or Resource period, provided they meet the requirements to earn a 340 privilege. *
A copy of your responses will be emailed to the address you provided.
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