PROFESSIONAL CHILDREN’S SCHOOL
132 WEST 60TH STREET  NEW YORK, NEW YORK 10023
212-582-3116  FAX: 212-956-3295 (High School)  212-582-1169 (Middle School)
e-mail: pmeertins@pcs-nyc.org or apena@pcs-nyc.org or mmann@pcs-nyc.org
FULL GUIDED STUDY FORM
Instructions to Students: It is understood that you will follow the daily assignment sheet in each of
your courses and adhere to the conditions of the Guided Study Agreement in the Student Handbook.
Take this form to all of your teachers and have them sign it. Return the entire form to Ms. Mann
after everyone, including your guardian and you, has signed it.
Name__________________________________Grade____Date of absence___________________
Reason for Absence_______________________________________________________
Describe the quantity of time that will be required for professional commitment:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Describe the quantity of time that will be available and allotted for schoolwork:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Mailing address while away_________________________________________________
_________________________________________________
Phone # while away___________________ Fax # while away______________________
Parent phone # ______________________
E-mail address while away__________________________________________________
(OVER)
List your courses below and names of teachers. Then see each teacher for his/her signature and
directions:
COURSE
TEACHER
TEACHER’S INITIALS AND
COMMENTS
Signature of Parent/Guardian_____________________________________ Date _____________
Signature of Student____________________________________________ Date _____________
Signature of Advisor____________________________________________ Date _____________
Signature of Academic Dean _____________________________________ Date _____________
12/8/10