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Student Name:
Grade:
Building:
Parent/Guardian/Legal Custodian:
Phone:
Please list the curricular objectives from which you wish to have your student excused and the class/grade in which each is taught. An example is provided below for you to follow.
| Objective | Class/Grade | Proposed Alternative Assignment | |
| Ex: | To describe behaviors that will minimized and prevent transmission of HIV |
Health Education / 6th Grade |
|
| 1. | |||
| 2. | |||
| 3. | |||
| 4. | |||
| 5. | |||
| 6. |
I have reviewed the Human Growth and Development Program goals, objectives, and materials and wish my student be excused from class when these objectives are taught. I understand my student will incur no penalty but may/shall be required to complete an alternative assignment that relates to the class and is consistent with assignments required of all students in the class.
Signed: ________________________________________________________ Date: ___________________
(Parent, Guardian, or Legal Custodian)
Signed: ________________________________________________________ Date: __________________
(School Administrator)
Reviewed: 9/13; 2/15; 4/18; 6/21; 2/24
Related Policy: 603.11
IASB Reference: 603.05-E(1)