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AppleWorks Document  |  1986-05-15  |  2KB  |  31 lines
  1. O=====|====|====|====|====|====|====|====|====|====|====|====|====|====|====|===
  2.  STUDENT PRIVILEGE REQUEST FORM
  3. I___________________________________would like to use my________________level
  4. privilege of_________________________________________________________________'
  5.                 (Plans for privilege)
  6. On___________________from______________am/pm to________________________am/pm.
  7. Transportation to be used will be____________________________________________
  8. I am going with______________________________________________________________
  9. ___________________________________is going to supervise me (if needed).
  10.   (Staff member)
  11. Staff member's signature__________________________________Date_______________
  12. Housefather's signature___________________________________Date_______________
  13. Dean's signature__________________________________________Date_______________
  14. Note:  This form must be signed by the Dean two (2) days before
  15.        planned activity.
  16. -----------------------------------------------------------------------------
  17. STUDENT PRIVILEGE REQUEST FORM
  18. I___________________________________would like to use my________________level
  19. privilege of_________________________________________________________________'
  20.                 (Plans for privilege)
  21. On___________________from______________am/pm to________________________am/pm.
  22. Transportation to be used will be____________________________________________
  23. I am going with______________________________________________________________
  24. ___________________________________is going to supervise me (if needed).
  25.   (Staff member)
  26. Staff member's signature__________________________________Date_______________
  27. Housefather's signature___________________________________Date_______________
  28. Dean's signature__________________________________________Date_______________
  29. Note:  This form must be signed by the Dean two (2) days before
  30.        planned activity.
  31.