USH Syllabus Acknowledgement and Parent Contact Information
Corby - 2025-26 
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Syllabus Acknowledgement - STUDENT
I have read and thoroughly understand with great detail the expectations, rules, and procedures that are expected of me as a student enrolled in this course. Moreover, I have read and agree to abide by the tenants set for in the honor code policy. I realize that I am responsible for all rules, regulations, procedures, and course requirements set forth in all classes, the student agenda, and the district policy manual, and I will be held accountable for the contents of this class and supporting documents.  
Indicate that the student understands the policies and procedures outlined in the syllabus by typing his/her name. (Last, First) *
Block *
Student Email Address (District) *
Please include the @stu.lexrich5.org
Do you have any questions regarding the syllabus? 
Syllabus Acknowledgement - PARENT
I have read thoroughly the contents of this syllabus and discussed with my child the expectations of him/her in this course.
Parent/Guardian, please Indicate that you understand the policies and procedures outlined in the syllabus by typing your full name. *
Do you have any questions regarding the syllabus? 
If you would like a hard copy of the syllabus, please indicate that here. A digital copy of the syllabus may be accessed at any time on my website and in the student's Google Classroom. *
Required
Is there anything you would like to share with me regarding your student?
Parent/Guardian Contact Information
Please type n/a below for any information that is not applicable.  
Parent/Guardian Name (1) *
Work Phone
Cell Phone *
Email Address *
Parent/Guardian Name (2)
Work Phone
Cell Phone
Email Address
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This form was created inside of Lexington/Richland School Dist. 5.