Program Exemptions Form
I request that _________________ be excused from participation
in __________________________________________________
This request is based upon religious beliefs or disability. (Please explain)
__________________________________________________________
__________________________________________________________
I understand if this request is granted, the student will have a comparable assignment for which he/she will be held accountable. Further, the student is to be excused only for the topic(s) specified above.
Request Granted _____ (initials)
Request Denied ______ (initials)
Parent__________________________________Date _____________
Principal ________________________________Date _____________