Poth High School Schedule Change Request Form
RETURN FORM WITH PARENT SIGNATURE TO OFFICE
Schedules will be changed only for the following reasons:
1. Sequence of courses is out of order.
2. Incomplete schedule. Keep in mind that in some cases, your alternate course had to be used in
completing your schedule.
3. Failure of a course that must be repeated.
4. A summer school course has been passed.
5. An academic need to switch from a Pre-AP, AP, or Dual Credit Course to a regular course.
Name: ________________________________________ Grade Level: __________________
I request the following change(s) to my schedule:
Reason for request:
_____________________________________________________________________________________
_____________________________________________________________________________________
Student Signature: ________________________________________ Date: _____________________
Parent/Guardian Signature: __________________________________ Date: _____________________
Contact Number: ______________________ Contact E-mail: _________________________________
* We may not be able to honor requests due to full classes or scheduling conflicts. Once your schedule
is changed, a new schedule will be sent to you.
Course Schedule Change
Counselor’s Signature: ___________________________________ Date: _____________________
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