INDEPENDENT SCHOOL DISTRICT 196 Rosemount-Apple Valley-Eagan Public Schools Educating our students to reach their full potential Series Number Title 604.4.1.3.4P Adopted November 1986 Revised January 2013 Staffing Summary for Middle School Student Participation in High School Junior Varsity or Varsity Athletic Activities—Gifted Athlete Student Student # School Grade A. Date Summary of Teacher Comments 1. Academic: 2. Behavior (in class): 3. Social (relationship to peers): B. Special concerns expressed by teachers and psychologist, which may interfere with this student’s movement to the junior varsity or varsity level of competition. (If none, answer none.) C. Present at staffing: Title Procedures/604.4.1.3.4P/1-4-13 Name