Date:_____________
Student’s Name:__________________________________ Grade:_____ Homeroom:________
Address:________________________________________ Zip:_______ Phone:____________
Place of Employment: ________________________________________ Phone:____________
Address:___________________________________________________ Zip: _____________
Name and Title of Employer: _____________________________________________________
Please indicate working hours: From:________________ To:_______________
Signature of Employer :__________________________________
THE EMPLOYER AND PARENT WILL BE CONTACTED BY THE SCHOOL TO VERIFY EMPLOYMENT
Date Issued:___________________
Dear Parent:
Your son/daughter has requested permission to leave school during the last period (study hall) to work. This permission may be granted provided:
1. Student has a passing grade in all subjects and provides evidence of employment.
2. Students must leave campus immediately at start of the last period of the day. No loitering on campus or in parking lots.
___________________________________
Signature of Student
___________________________________
Signature of Parent/Guardian
_____________________________________
Attendance Office
___________________________________
Address
_________________________________
Counselor
___________________________________
Business Phone
_____________________________________
Vocational Counselor
___________________________________
Home Phone
________________________________
Assistant Principal