AB 104 Grade Retention Interest/Request Form
Please complete by August 16th.  A staff member from the school site will contact you within 30 days of filling out this form to discuss your interest/request. The school must notify the parent/guardian of a final determination of the student’s retention within 10 calendar days of the consultation.
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Student First Name *
Student Last Name *
Current Grade level *
Student ID
School Name *
First Name (PARENT/GUARDIAN/EDUCATIONAL RIGHTS HOLDER) *
Last Name (PARENT/GUARDIAN/EDUCATIONAL RIGHTS HOLDER) *
Email address (PARENT/GUARDIAN/EDUCATIONAL RIGHTS HOLDER) *
Phone number (PARENT/GUARDIAN/EDUCATIONAL RIGHTS HOLDER) *
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