Coverage Request Form
Who Completes this form:

Regular education teachers requiring coverage for IEP meetings; special education teachers requiring coverage for IEP meetings; faculty members who are coaches who require coverage for end of the day events (early dismissals).

Guidelines for Completion:
1. Complete the entire form.

2. Submit the completed form (using the submit button below) to Mrs. Goode within 10 school days of the date that you need coverage (for example, if you need coverage on November 13, 2007, white period 4, you must submit the form by 4th period on October 30, 2007.

3. If Mrs. Goode does not receive the request within 10 school days of the date/period coverage is needed, it will be the teacher's responsibility to arrange for coverage. (The regular education teacher whose duty it is to attend an IEP meeting and who did not submit the request in a timely manner will have to get coverage. The special education teacher who failed to submit timely notice to the regular education teacher and/or who failed to submit the notice in a timely manner will need to get the regular education teacher or himself/herself coverage. The coach who did not submit the request in a timely manner will have to get coverage.)

Please complete the following information:
Name
Your answer
Date of Request
MM
/
DD
/
YYYY
Date Needed
MM
/
DD
/
YYYY
Period Needed
Your answer
Reason
Your answer
Submit
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