Montclair HS External Course Request Form
Submit Form to Student's Guidance Counselor at:
Montclair High School Guidance Office, 100 Chestnut Street, Montclair, NJ 07042 or email
the Secretary to the Director of Guidance, Susan Iovine, siovine@montclair.k12.nj.us .
For questions please contact: Director of Guidance, Dustin Bayer,
Telephone: 973.509.4118
Email: dbayer@montclair.k12.nj.us
Team Office: ____________ Counselor Name: _________________________________
Student:
Name of Institution Providing Course: ______________________________________________
Is this program accredited? ___ Yes ____ No If yes, by whom? __________________________
Course Name: ________________________ Course Level: __________ Credits: _____
Course Description (can be attached)________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I am requesting this course for the following purpose: (Check all that apply)
____ To meet a Graduation Requirement ____ To obtain Credits
____To Transfer Credit from another School ____ For Advancement (120 hours)
____ Other (Explain): ___________________________________________________________
By signing below you acknowledge that this course is eligible for credits only and will NOT be
calculated in the MHS GPA:
Student Signature ________________________________ Date ___________________
Parent Signature _________________________________ Date ___________________
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OFFICE USE ONLY
Decision: ______ Approved _____ Denied
Principal Signature ______________________________ Date ________
Reviewed by: ___ Guidance Director ___ Assistant Principal ___ Director of Curriculum
Course Name to be entered in system _______________________________________________
Transcript Received: _____ Grade Earned: ______ Credits Approved: ________ Level_______
Date Entered in system: _____________
Initials: _______ Comments: __________________________________________________
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