Lake Zurich High School
300 CHURCH STREET LAKE ZURICH, ILLINOIS 60047
PHONE: (847) 438-5155 FAX: (847) 438-5989
Student/Parent Generated Level Change Request Form
Please complete one form per subject area level change request.
I want to override the course recommendation for:
_________________________________________
Student Name
_________________________________________
Recommended Course & Level
________________________________
Year in School Waiver Takes Effect
to
________________________________
Course Being Requested
It is my desire that my child take this course provided space is available. I have spoken to my child’s current teacher
_______________________________ on ____________ to discuss my child’s strengths and areas for growth in
(Current Teacher’s Name)
(Date)
reference to his/her placement for the coming school year.
By signing and sending this form, I am indicating that I understand that I am requesting a course change against
the teacher’s recommendation. This change may not be in the best interest of my child. I understand that once
this change is made, my child will not be able to change out of the requested level.
Furthermore, I agree to provide the necessary help/support to ensure my child’s success in the course, which was not
the course for which he/she was recommended.
_________________________________________
Parent Signature
______________
Date
_________________________________________
Student Signature
______________
Date
Once this form is complete, please return the form by Tuesday, February 23, 2016, in one of the following ways:
•
•
Scan the form and e-mail it to waivers@lz95.org
Return the form to: Lake Zurich High School
Attention: Eric Hamilton
300 Church Street
Lake Zurich, IL 60047
For office use only:
_________
DC Initials