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OUTSIDE COURSE PERMISSION FORM (NONREMEDIATION) 20112012

Student Name and ID#:

Course to be taken (you may not know all this information at the time of course requests):

Course:

School:

Dates:

Contact Person, Phone, Email:

(This is the person who registers you for the outside course)

Teacher/professor, Phone, Email:

(This is the person who teaches the outside course)

Student statement and signature: I understand that it is my responsibility to learn all policies and procedures for this class, attend all class sessions, complete all work on time, successfully pass, and deliver copies of my official transcript to my counselor and the JCP Director of Student Services. CPS and JCP cannot be responsible for my behavior or my safety when I am attending an offsite class. I understand that I am expected to attend a study hall at JCP when my outside course is not in session.

Signed and dated:

Parent Guardian statement and signature: I understand that it is my student’s responsibility to learn all policies and procedures for this class, attend all class sessions, complete all work on time, successfully pass, and deliver copies of the transcript to the counselor and the Director of Student Services. I also understand that CPS and JCP cannot be responsible for my child’s behavior or safety when attending an offsite class. Finally, I understand that my student is expected to attend a study hall at JCP when the outside course is not in session.

Signed and dated:

JCP Counselor:

JCP Department Chair:

Only for acceleration when the student plans to continue studies in the area.

JCP Assistant Principal:

Comments: For Office Use Only

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