Teaneck High School - Summer School/College Course Request Form

Counselor Name: _________________________________

Student:

Last Name	First Name	Grade	Request Date

Name of Institution Providing Course: ______________________________________________

Course Name: ________________________	Course Level: __________	Credits: _____

Course Description (can be attached)________________________________________________

______________________________________________________________________________ ______________________________________________________________________________

I am requesting this course for the following purpose: (Check all that apply)

____ To meet a Graduation Requirement	____ To obtain Credits

____ For Advancement (120 hours)

____ Other (Explain): ___________________________________________________________

By signing below you acknowledge that this course is eligible for credits only and will NOT be

calculated in the THS GPA:

Student Signature ________________________________

Parent Signature _________________________________

Date ___________________

Date ___________________

---------------------------------------------------------------------------------------------------------------------OFFICE USE ONLY

Decision: ______ Approved _____ Denied

Dir. Of Guidance Signature ______________________________	Date ________

Reviewed by: ___ Guidance Director ___ School Counselor ___ Subject Supervisor

Course Name to be entered in system _______________________________________________ Transcript Received: _____ Grade Earned: ______ Credits Approved: ________ Level_______ Date Entered in system: _____________
Initials: _______	Comments: __________________________________________________

Submit Form to Student's School Counselor and Mr. Hollis via email Charles Hollis, chollis@teaneckschools.org.
For questions please contact:
Director of Guidance, Keshia Golding-Cooper, Email: kcooper@teaneckschools.org