Hartford Central School District

Academic Re-eligibility Form

Any student who is failing two or three courses at the end of a 5-week or quarter marking period is placed on academic probation. In order for the students on academic probation to participate and go to extracurricular activities they need to attend tenth period assistance in the courses that they are failing, complete the form below, and return it to the Main Office by Friday at noon. If any of these conditions are not met, the student will be ineligible for participation or attendance at extracurricular events.

Student Name:__________________________________________________________________

Grade:_________________________________

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Course:____________________________________________________

Teacher:___________________________________________________

Date of Tenth Period Assistance:________________________________

Alternative Meeting Time:__________________________________________________

Teacher’s Signature:_____________________________________________________________

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Course:____________________________________________________

Teacher:___________________________________________________

Date of Tenth Period Assistance:________________________________

Alternative Meeting Time:__________________________________________________

Teacher’s Signature:_____________________________________________________________

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Course:____________________________________________________

Teacher:___________________________________________________

Date of Tenth Period Assistance:________________________________

Alternative Meeting Time:__________________________________________________

Teacher’s Signature:_____________________________________________________________