University High School Form Request

UNIVERSITY HIGH SCHOOL FORM REQUEST

***Please read the U-High form request procedures, and complete the portion that applied to you. Forms are due to the Counseling Center within the first 5 days of class, unless otherwise specified.

Date:______

Student Name: ______Grade: 9 10 11 12

CLASS AUDIT-Class will be taken for no credit, but the student is required to participate in all work.

Semester: Fall Spring

Course Title: ______

Teacher Signature: ______

DEPARTMENT/OFFICE ASSISTANT-This is for seniors only; must have a cumulative 3.0 GPA to qualify and meet graduation requirements.

Semester (circle one): Fall Spring Full-Year

Position (select one): Department Assistant_____ Office Assistant_____

Dept Chair/Office Name (print) ______Dept Chair/Office Signature______

Class Period Assisting: 1 2 3 4 5 6 7 8

DUAL CREDIT ENROLLMENT-There is an additional form required for both Heartland & ISU. The Heartland DE form needs to be signed by the counselling department and then taken to Heartland for enrollment. The completed ISU DE form needs to be returned to the Counseling Center. ISU will be in contact with those interested in DE upon completion of the form.

Institution (circle one): Illinois State University Heartland Community College

Anticipated Course(s):______

Department Chair Signature:______

I agree/disagree (circle one) with the course the student is enrolled in for the semester indicated above (to be completed by Department Chair).

Grade Improvement-The original grade must have been a D or F to qualify for grade improvement. The new grade will replace the old grade on the transcript.

Course Title:______Original Grade Earned: D F

Original Year & Semester taken:______Fall Spring Summer

Illinois Virtual School-Online courses available to U-High students. Department Chair signature is required. Cost is $225 per semester & $250 for summer courses. Courses selected must be from outside the curriculum taught at U-High.

Semester (circle one): Fall Spring Summer IVS Course Requested:______

Reason you are requesting to take an on-line course:______

Department Chair Signature:______

Pass/Fail-Class is taken for Pass/Fail instead of a grade for the semester requested. A Pass will count for credit but not be figured in the GPA of the student. If an F is achieved, the grade will figure into the GPA of the student and no credit will be given.

Semester (circle one): Fall Spring Course Title:______

Teacher Signature:______

Physical Education Waiver-For Juniors and Seniors only. A U-High class will replace PE for the semester of an IHSA sport. If choosing an Academic Overload, student must also complete an Independent Study form.

Semester (circle one): Fall Spring

Basis for Waiver Request:

_____ Interscholastic Athletics (name of sport) ______

_____Other course required for college admission

_____Other course required for high school graduation

_____Medical (Please attach Doctor’s note)

_____Advanced course overload (must take an Independent Study with the Physical Education Dept and attach the

Independent Study Form)

Student Signature:______Date:______

Parent Signature: ______Date: ______

Counselor Signature: ______Date:______