Author: GRPS

Academic Up-Grade Program
Registration Form

Student:

Grade:

Date:

Why do you want to participate in the Academic Up-Grade Program?

What is your goal for your grades this marking period?

Period

Teacher

Subject

Room

Grade/Goal

1

2

3

4

5

Student Advocate:

Please indicate the times that would work best for you to receive study support (Tutoring):

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

3:30—5 p.m.

3:30—5 p.m.

3:30—5 p.m.

3:30—5 p.m.

3:30 —5 p.m.

9 a.m.—12 p.m.

Parent/Guardian Information:

Name:

Relationship:

Phone:

Address:

Participation in the Academic Up-Grade is voluntary and requires that student have consent from their parent/guardian. By signing, I hereby consent for the above named student to participate.

Parent/Guardian Signature: