OAK HILL MIDDLE SCHOOL

Schedule Change Request Form

Student_______________________________ Date____________________________

Current Schedule

1^st Period_________________________ Teacher______________________          

2^nd Period_________________________ Teacher______________________          

3^rd Period_________________________ Teacher______________________          

4^th Period_________________________ Teacher______________________          

5^th Period_________________________ Teacher______________________          

New Schedule

1^st Period_________________________ Teacher______________________          

2^nd Period_________________________ Teacher______________________          

3^rd Period_________________________ Teacher______________________          

4^th Period_________________________ Teacher______________________          

5^th Period_________________________ Teacher______________________          

Approved by:______________________      Date:_____________________

                       Administrator’s Signature

Please forward this form to the registrar so the changes may be made in student’s records.

Changes to schedule were made on:

Date:_____________________________________       Registrar’s Initials:_________________