CONNECTIONS QUARTER CREDIT REFERRAL -Please FILL out AFTER course completion

Student Name:  _______________________________________________Grade:  __________

COURSE TO BE COMPLETED:  ________________________________ (new sheet per course)

Course Completion Date: ___________________________

Student and parent contact information (email/cell phone)

____________________________________________________________________

REQUIRED APPROVAL

Guidance Counselor    NAME:  ____________________________________________

Principal                      NAME:  ____________________________________________

Content Teacher         NAME:  ____________________________________________

GUIDANCE COUNSELOR (please fill out form after course completion)

Identify ONE day the student can commit to coming to the lab.  ALL STUDENTS MUST BE ENROLLED in a Quest or LAB session.  Students MUST be enrolled and meet content are teacher 10^th period on A days.

M                                 T                                  W                                TH                                F

# OF HOURS TO BE MADE UP   _________

GRADE:  Q1   _____    Q2   _____       Q3   _____       Q4   _____

 FINAL GRADE:  _____

STUDENT/TEACHER (please complete)

We, (student, parent/guardian/teacher) agree to the requirements as outlined above.  In the advent the student meets these requirements the students’ grade shall be raised to a 65 (minimum).

Student Name:  _______________________ Signature:  ____________________ Date_______

Teacher Name:  _______________________Signature:  _____________________Date_______

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