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603.11-E - Human Growth and Development Student Excuse Form

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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)