Homeroom teacher:________________________ Current School Year:___________
On the permanent record label, the homeroom teacher marked “placed” in the next grade.
The classroom teacher has noted the following reasons based on the student’s current
school progress for this placement. Academic standing, expectations, and deficiencies
were a part of this decision. This placement into the next grade is in contrast to
Teacher’s Signature:___________________________________ Date:___________
Principal’s Signature:__________________________________ Date:____________