10th Grade 340 Request Form

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WISCONSIN ACT 340 PRIVILEGE REQUEST FORM

Under Wisconsin Act 340, high school pupils who demonstrate a high level of maturity and personal responsibility may leave the school premises for up to one class period each day if the pupil does not have a class scheduled during that class period.

The student named below is requesting permission to be released from school for their 9th hour resource period, under Wisconsin Act 340. Student understands that this is a request for a privilege and is not a guaranteed right. This privilege will be approved, denied or revoked at any time based on attendance (this includes tardiness), grades (students earning a D or F for any reason) and/or school/classroom behavior.

It is also understood that for this privilege to be granted the student must receive positive support from teachers, Student Services and the administration.

In addition, a parent MUST CONFIRM that when school is meeting in-person, this student will have a way to leave the school building during the 340 period. If student is unable to leave the building, they should not request a 340.

Grades must be C- or above to be eligible for this privilege and must remain that way to maintain a 340 status.

Email *

Student First Name *

Student Last Name *

Student Grade *

10th Grade

I would like to request a 340 during Resource at the end of the school day (2-2:50 pm). *

Yes

Parent Name, First and Last *

I give my student permission to leave the school premises during the resource period (2-2:50 pm), provided they meet the requirements to earn a 340 privilege. My permission also confirms that the student does have a way to leave the building during their 340 period - students will not be allowed to remain in the building due to social distancing and COVID safety guidelines. *

Yes

No, I do not wish for my student to have a 340 period at this time.

A copy of your responses will be emailed to the address you provided.

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