2016 - 2017 Extended Learning Change of Schedule Add/Drop Form
THIS FORM MUST BE SUBMITTED ONE MONTH PRIOR TO DATE OF THE SCHEDULED REQUEST FOR ALL EXTENDED LEARNING PROGRAM SCHEDULE CHANGES. BEFORE SCHOOL PROGRAM REQUESTS REQUIRE ONLY 24 HOUR NOTICE. EXTENDED LEARNING PROGRAM REQUESTS REQUIRE A ONE MONTHS ADVANCE NOTICE. A $10.00 FEE WILL BE CHARGED FOR REQUESTS THAT DO NOT ALLOW FOR A MONTHS NOTICE. ALL FORMS WILL BE TIME STAMPED FOR YOUR CONVENIENCE. NOTE: A SEPARATE REQUEST FORM SHOULD BE SUBMITTED FOR MORE THAN ONE REQUEST.
Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Please choose your student's location from the below list: *
Parent's Email *
Your answer
EFFECTIVE Change Date *
SCHEDULE CHANGES WILL BE PRORATED BEGINNING THE FIRST OF THE MONTH OF THE APPROVED CHANGE. ADD ON DAY/MORNING CHARGES WILL BE ADDED TO YOUR MONTHLY BILL AS A STATEMENT CHARGE.
MM
/
DD
/
YYYY
Program Schedule Change Reflects *
Current Schedule *
Required
Current Days of Attendance *
Required
Requested Change Schedule *
Required
Requested Schedule Change of Day(s) or Add On Day *
Required
DROP A DAY OR MORNING
COMMENT
Your answer
A copy of your responses will be emailed to the address you provided.
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