Student Course Extension Request 2020-21

Student Course Extension Request 2020-21
JEDI Virtual School
1221 Innovation Drive, Suite 219
Whitewater, WI 53190
Phone: (262) 473-1469
Fax: (262) 472-2269
www.jedivirtual.org
Student Course Extension Request
Student Name *

First Name Last Name
Course in Which Extension is Needed *
Teacher Name *
Teacher E-mail *
Note:
Reason Extension is Needed *
Please provide a full explanation as to why you need an extension in this course.
School District *
If you have selected Open Enrolled - Other, please input your resident district
Name of Learning Coach *

First Name Last Name
Name of Student Advisor *
Name of Person Submitting Form *

First Name Last Name
E-mail of Person Submitting Form *
Should be Empty: