SEATTLE PUBLIC SCHOOL
HIGH SCHOOL PHYSICAL EDUCATION (PE)
WAIVER REQUEST FORM
PE Waivers will be granted for only ONE Semester at a time. A waiver will only be approved if the student has proven they
have met the PE competency. A student can only be waived from the credits for physical education. A student must take
other classes to make up for the missing credits to meet minimum high school graduation requirements. Students who are a
Teacher/Office Assistant or has a hole in their schedule may not receive a waiver for the term.
The following categories qualify as allowable reasons for the administrator/designee to consider waiving PE.
Attach a copy of your High School Transcript or Academic History and your 4-year course plan.
1) Physical education completed. 1 semester 2 semesters
2) Have you received a waiver in physical education?
Yes, semester waived (e.g., Second semester, Sophomore Year) _________________________________
No
3) Check all that apply.
Enrolled as a Teacher’s Aide (TA) or Office Assistant (OA)
Enrolled in study hall
Have you had any open periods e.g., late arrival, early dismissal?
1. Physical Disability HPE8203 - Attach verification from the IEP, doctor or health care professional indicating that
participation in a PE class will be detrimental to student’s health.
2. Religious Belief HPE8204 - The student’s religion stipulates against participation in physical education.
Verification from student’s religious leader is required.
3. Directed Athletics HPE8205 - Participation in Seattle School District extra-curricular athletic programs
requires a coach’s verification. Participation in community-based organized athletics requires a
weekly log documenting a minimum of 80 hours (during the semester that the student requests the
waiver- summers do not count) of regular workouts, practices, and competitions. Parent/Guardian
and the coach’s verification are required. The transcript must show 5 semesters of coursework.
4. Military Science HPE8206 - Attach proof of enrollment in a military science class.
5. Employment HPE8207 - Student must work to assist family or student is currently self-supporting. Attach
verification from employer.
6. Other Good Cause HPE8208 – (for Juniors/Seniors only) The transcript must show 5 semesters of coursework.
Please explain: __________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Name: _________________________________ Student ID #: _____________ Class of: _____________________
PE Competency Test Score: _______ (meeting standard = 3 or higher) Waiver Category #: ___________
Athletic Program Participated in: _______________________________________ Semester ending: ___________
_________________________________ ___________________________________
(Teacher/Coach Signature) (Parent/Guardian Signature)
Office Use Only __ Approved __ Denied (provide student direction to register for PE)
__________________________________________ ____________________
Administrator/Designee Signature Date
____________________________________________ _____________________
Entered by Data Registration Specialist Date
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