CRESCENTA VALLEY HIGH SCHOOL
Health Online Course Request Form
Student Name ___________________________________ ID # ________________ Grade ___________
Parent Name _______________________ Phone _______________ Email ________________________
Course Name
Health 041 at BYU: www.is.byu.edu
Please briefly explain the reason you are requesting that your student take a high school course online.
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*Please consult the online/non-GUSD school for proctoring guidelines for testing and transcript submission.
I understand that all course work and granting of units is subject to the discretion of the school principal, per Glendale Unified
School District Board policy. Any online/non-GUSD course taken must be pre-approved by the counselor and school
administrator. Students will receive no high school credit for a course that is completed without approval.
**If you are interested in pursuing athletics beyond high school, all courses taken, whether traditional courses or
online, must be approved through the NCAA eligibility center as college prep courses.
∆∆IMPORTANT: BYU Independent Study has NO courses approved through the NCAA as college prep courses.
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Parent Signature
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Date
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Student Signature
Date
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OFFICE USE ONLY
Student will earn _______ high school credits upon successful completion of the above course. This
course must be completed, and a final transcript sent to Crescenta Valley High School by
________________ in order to receive high school credit from CVHS. If you do not want your final
online grade reflected on your GUSD transcript, please do not submit your online transcript to CVHS.
 Request approved
 Request not approved
Counselor Signature:________________________
Date:___________________
01/2016