ALTERNATE GRADUATION REQUIREMENT
REQUEST FORM / South Lyon Community Schools
345 South Warren
South Lyon, Michigan
48178
Date of Request:
STUDENT INFORMATION – (Complete all sections.)
Name of Student: / Grade: / Anticipated
Graduation
Date:
Name of Counselor:
Requested By:
(Please check the
appropriate box) / ☐Parent / Name & Contact Information:
☐Guardian
☐Student
(emancipated or over 18 yrs old)
Please indicate if the following applies: / ☐Student is eligible for special education and has an Individual
Education Plan (IEP).
MODIFICATION REQUEST – Select which area(s) of the Michigan Merit Curriculum are in need of proposed modification(s).
Mathematics – 4 credits
☐Algebra II
☐4th Math to be taken Junior year
Alternate Mathematics Course Choice:
______/ Science – 3 credits
☐Chemistry/Analytical Chemistry
☐Geophysical Science/Physics
Alternate Science Course Choice:
______
Social Studies – 3 credits
☐Economics / World Language – 2 credits
☐2nd Credit of Language
Additional credit in which subject?
______
Physical Education/Health – 1 credit
☐Foundations of Health/PE
☐Healthy Life Habits
Additional credit in which subject?
______/ Applied, Visual, and Performing Arts
☐1 credit
Additional credit in which subject?
______
SIGNATURES
Requested by: / Date:
Received by: / Date:
*After review of the PC or AGR request, a counselor will be in contact to schedule a meeting.
Eligibility for Use of Personal Curriculum(PC) or Alternative Graduation Requirement Plan (AGR)(For Office Use Only)
A Personal Curriculum or Alternative Graduation Requirement Plan may be appropriate for a student who has demonstrated one or more of the following:
☐ / Student wishes to go beyond the academic requirements.
☐ / Student wishes to modify Mathematics requirements.
☐ / Student wishes to modify Social Studies requirements.
☐ / Student has an IEP and wishes to modify the credit requirements based on his or her disability.
☐ / Student has transferred from out of state or a non-public school.