SAMPLE
XYZ Charter
719
Fourth Street
Anytown,
TX
555/555-1234
OFF-CAMPUS PHYSICAL EDUCATION APPLICATION
Name: ___________________________________ Sex: M_____
F_____ Grade: __________
Address: _________________________ City:
______________ State: _______ Zip: _______
Parent/Guardian Name: ________________________________________________________
Telephone: ____________________ Signature of
Parent/Guardian: _____________________
Activity:
___________________________________________________________________
Name of Agency or Facility: ____________________________________________________
Address: _________________________ City:
_____________ State: _______ Zip: ________
Instructor: ______________________________________
Phone: ______________________
FOR THIS APPLICATION TO BE CONSIDERED FOR
ANY SEMESTER IT MUST BE RETURNED TO THE DIVISIONAL DIRECTOR, ALONG WITH
THE CORRECT FEE, NO LATER THAN THE DAY BEFORE THE FIRST DAY OF CLASS OF THAT
SEMESTER.
1. I am applying for admission into Off-Campus
Physical Education for the:
________ Fall
Semester ________ Spring Semester ________ Both Semesters
Fee:
_________ $XX/Semester _________ $XX/year
2.
If
accepted into the Off-Campus Physical Education I would like the following
schedule. Only students participating in
a minimum of I5 hours per week may be dismissed from any part of the regular
school day. These options are subject to
the approva1 of the Curriculum Director. (Circle
only one)
Late Arrival Early Dismissa1 Study Hall
TO BE COMPLETED BY SCHOOL
OFFICIALS:
Director/Administrator:
___________________________________ Date: _______________
III.
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