CERTIFICATION OF CLASS CHANGE Date: _____

							REQUEST FOR GUIDANCE APPOINTMENT                                                 (Must Be Completed in Full)

Student’s Name: _________________________________                                Date: ______________________________
Student ID #: _____________               Grade / Section: _________             Homeroom Teacher: ___________________

Counselor:
      Mrs. Hill              ________                 Mr. Glassberg ________                  Mrs. Ace          ________
         Mrs. Braungard ________                      Ms. Klarer        ________              Mrs. Cohen        ________
         Mrs. Clayton        ________                 Mrs. Lin          ________              Mrs. Hohner ________
         Mrs. Cone           ________                 Mr. Petrucelli ________                 Ms. Lewis         ________
         Mrs. Cundari        ________                 Mrs. Randazza ________                  Ms. Martins       ________

Study/Elective Period _____________                   Room # ____________                 Lab Day _________________

I would like to discuss _______________________________________________________________________

(To be filled out by counselor)
GUIDANCE APPOINTMENT                         (Student, please use this as a pass from Guidance)

DATE _____________                  TIME ______________                 SIGNED _________________________________
                                                                                          (Counselor)
TIME RETURNED

----------------------------------------------------------------------------------------------------------------------------------------

REQUEST FOR GUIDANCE APPOINTMENT                                                 (Must Be Completed in Full)

Student’s Name: _________________________________                                Date: ______________________________
Student ID #: _____________               Grade / Section: _________             Homeroom Teacher: ___________________

Counselor:
      Mrs. Hill              ________                 Mr. Glassberg ________                  Mrs. Ace          ________
         Mrs. Braungard ________                      Ms. Klarer        ________              Mrs. Cohen        ________
         Mrs. Clayton        ________                 Mrs. Lin          ________              Mrs. Hohner ________
         Mrs. Cone           ________                 Mr. Petrucelli ________                 Ms. Lewis         ________
         Mrs. Cundari        ________                 Mrs. Randazza ________                  Ms. Martins       ________

Study/Elective Period _____________                   Room # ____________                 Lab Day _________________

I would like to discuss _______________________________________________________________________

(To be filled out by counselor)
GUIDANCE APPOINTMENT                         (Student, please use this as a pass from Guidance)

DATE _____________                  TIME ______________                 SIGNED _________________________________
                                                                                          (Counselor)
TIME RETURNED