Request for Approval of Part‐Time Daily Attendance Office of the Chief Operating Officer Montgomery County Public Schools Rockville, Maryland 20850
I.
To be completed by the student and parent/guardian and submitted to the principal when a program requiring less than full‐time daily attendance is requested. _________________________________________________ _______ _________________ Student’s Name Grade ID# _______________________________________________________________ ____________________ Home Address Telephone Number Reason for request _____________________________________________________________________ _____________________________________________________________________________________ Transportation arrangements _____________________________________________________________ II.
We the undersigned, understand that if part‐time daily attendance is approved, the student will be permitted to be in the school and on school property at only those times specified on the student’s schedule. _______________________________________ ___/___/___ _______________________________ ___/___/___ Signature, Student Date Signature, Parent/Guardian Date
II. To be completed by the school counselor and submitted to the princip
Conference was held with student and/or parent (date) ___/___/___ Participants in conference ______________________________ ____________________________ ______________________________ ____________________________ □ After discussion, the request for a part‐time program was withdrawn. □ A part‐time program and schedule was planned. □ No □ Yes 1 2 3 Enter Subjects for Each Period Scheduled
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□ Recommend approval □ Recommend disapproval Reason for recommendation ___________________________________________________________________________ ___________________________________________________________________________________________________ ______________________________________ ___/___/___ Signature, School Counselor Date III. To be completed by principal The request for authorization to attend school on a part‐time daily schedule is: □ Approved □ Disapproved for the following reason _________________________________________________ _____________________________________________________________________________________________ ______________________________________________ ___/___/___ Signature, Principal Date 9/14 SH