PREARRANGEMENT FORM
*THIS DOCUMENT ALLOWS A STUDENT TO START CLASS LATER THAN 9:30 OR LEAVE EARLY FOR A DAY WITHOUT CONSEQUENCE IF ACCOMPANIED PREARRANGED WITH AN INSTRUCTOR/ADMINISTRATION
STUDENT NAME
*
TODAY'S DATE
*
/
Month
/
Day
Year
Date
DATE REQUESTED FOR PREARRANGEMENT
*
/
Month
/
Day
Year
Date
REASON/COMMENT: arrive late or leave early please add time requested
*
STUDENT SIGNATURE
*
INSTRUCTOR SIGNATURE
*
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