Performance Release Request Form

Name*

E-mail*

Choose 'Add Row' for Multiple Selections*

Requests must be approved by your major teacher before submission.

Has your major teacher approved this request?*

YesNo

I have informed my classroom teachers of my desire to be released and have made alternative arrangements to complete any missed work.*

Yes

Requests must be submitted at least 7 days prior to requested release date. Email Mr. Kelly, Ms. Rainoff, Ms. Vercelli, and Mrs. Moon for any requests that are fewer than 7 days away.

Start Date of event(s) for which release is being requested*

Date

Start Time of event(s) for which release is being requested (Eastern Standard Time)*

:HourMinutes AM/PM Option

End Date of event(s) for which release is being requested*

Date

End Time of event(s) for which release is being requested (Eastern Standard Time)*

:HourMinutesAM/PM Option

Departure date from campus for proposed travel plan*

Date

Departure time from campus for proposed travel plan (Eastern Standard Time)*

:HourMinutesAM/PM Option

Return date to campus for proposed travel plan*

Date

Return time to campus for proposed travel plan (Eastern Standard Time)*

:HourMinutesAM/PM Option

Non-refundable travel plans should not be booked until your release request is approved. Any travel plans made prior to an approved release request will not be eligible for reimbursement through the travel fund.

Are you an international student in F-1 status?*

YesNo

For F-1 students to be eligible for paid employment or curricular practical training, F-1 students must first complete one academic year in their program. Have you completed one academic year in your program?

YesNo

Category of absence*

Curtis-sponsored eventProfessional engagement/ gigAuditionCompetition

Reason for absence (please be specific)*

All Curricular Practical Training must be authorized by SEVIS prior to date of employment. Engaging in unauthorized paid employment is a violation and jeopardizes your F-1 status. To request authorization please submit the required information.

How are you being paid (if you are being paid)?

CurtisEmployer/Presenter

Name of Employer/ Presenter*

Address of Employer/ Presenter*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Additional Address Notes

Employer Contact Name*

First NameLast Name

Contact Phone Number or Email*

Venue/ Location of Performance(s)*

International students: check with Mr. McGovern for your new I-20 reflecting this employment.

This form will not be processed until you have received approval from your major teacher(s).

Time

Major Teacher's e-mail (2)

Major Teacher's e-mail (3)

Major Teacher's e-mail (4)

Major Teacher's e-mail (5)

Major Teacher's e-mail (6)