Glenbard Township High School District 87
Policy 6:310-E1
Instruction
Exhibit - Request for Seven (7) Period Physical Education Waiver, Grade 12 For the Classes of 2012 and 2013
Beginning with the class of 2014 and moving forward, the Physical Education Waivers Policy will be abandoned.
Starting with the Class of 2014 all students will be expected to enroll in a Physical Education Class.
Please fill out this form for the category(s) appropriate for your request. Have your
parent(s)/guardian(s) sign the form and return it to your guidance counselor.
Name____________________________________________________________ Glenbard ID#_____________
Address__________________________________________________________________________________
CATEGORY 1. INTERSCHOLASTIC ATHLETICS WAIVER
1. Interscholastic Team:______________________________ Coach:__________________________________
2. Grade Next Year: __________ Season: ___Fall ___Winter ___Spring
3. Were you a member of this team for the entire season last year? ___Yes ___No
4. Study Hall or course to be taken in place of P.E.__________________: Semester:________ Year:_________
Verification of team membership (Coaches Signature):____________________________________________
CATEGORY 2. ADMISSION TO AN INSTITUTION OF HIGHER LEARNING
1. Please attach documentation from the institution of higher learning showing that the course you are
requesting is required for admission to a specific institution.
2. Parent(s)/guardian(s), student and counselor have reviewed the filed 4-year plan which shows that the
requested course cannot be taken with a normal schedule of six (6) courses (including electives) plus
physical education.
3. Course(s) to be taken in place of P.E.______________________________ Semester:_____ Year:_____
CATEGORY 3. COMPLETION OF GRADUATION REQUIREMENTS
1. Parent(s)/guardian(s), student and counselor have reviewed the student’s transcript and 4 year plan.
These documents show that the requested course cannot be taken with a normal schedule of 6 courses
plus physical education.
2. Course to be taken in place of P.E.:________________________________Semester:_____ Year:_____
- - - - - - - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- - - - -- -
_______________________________________________
Approval of Application Parent(s)/Guardian(s) Signature
________________________________________________
___Approval ___Disapproval Guidance Counselor Signature
_______________________________________________
___Approval ___ Disapproval Building Principal Signature
DATED: January 10, 2005
REVISED: May 23, 2005
REVIEWED: January 17, 2006
REVIEWED: December 8, 2008
REVISED: February 9, 2009
REVIEWED: November 14, 2011
REVISED: January 9, 2012
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