Office of AIG Services
Nanci Lucas, Coordinator
Phone: 252-257-3442
WAIVER
In accepting a year of “time out” from AIG classes and/or other AIG
Services of my child: _____________________________________,
School ______________________________ Grade ____________,
(School NEXT Year)
(Next Year)
I hereby acknowledge that the AIG Specialist __________________
(Name of Teacher)
spoke to me a least one time mid-year about the performance of my
child this school year, and how grades and/or behavior were not
meeting what was expected of an identified AIG student.
My child __________________________ and I/we have decided to accept
(Student Name)
a year of “time out” from the challenge of the AIG program and
understand unless we indicate otherwise, he/she will be eligible for a
review of eligibility next school year. (Late Spring)
SIGNED: _______________________
DATE ______________
SIGNED: _______________________
(Student)
DATE ______________
PLEASE SIGN & RETURN TO OFFICE by May 10, _______(Year)
For Office Use Only:
Received in Office ______________
(Date)
Copy Placed in Student’s AIG File _______________ (Date) Copy sent to Coordinator ________________ (Date)
_______Copy in Student’s AIG File
_______Copy to Coordinator
IS – 119
04/05/2005