INTENT TO TAKE COURSE PASS/FAIL

This is my request to take the course listed below as pass/fail instead of receiving a numerical grade. I understand that this will not be included in computing a grade point average. I understand these are the requirements for pass/fail:

1. I have a 4.0 GPA
2. I have fulfilled requirements in the core area of the pass/fail course.
3. The course is not pre-AP or AP.
4. I am enrolled in 11^th or 12^th grade.

Name of Student:

(Please type or print clearly.)

Grade level: Junior Senior

Course:

Course:

Course:

Year or Semester:

The counselors’ office must receive this completed form by September 28, 2007.

Signature of student Date

Signature of parent Date