Class Exception Request by Supervisor

Students are not permitted to work during scheduled class times with limited exceptions. Complete this form if you as the supervisor approved worked during this scheduled class time due to an approved exception reason. Example: Class was canceled.

Your Name *
Your name

Your Email Address *
Your email address *

Student Name *
Student Name

Student ID *
Student ID

Provide the date and class start and end time that the student requested to work. Include as much detail as possible. (e.g. Tuesday, April 12, 2A - 2:25 pm - 4:15 pm) * *
Provide the date and class start and end time that the student requested to work. Include as much detail as possible. (e.g. Tuesday, April 12, 2A - 2:25 pm - 4:15 pm) *

Which acceptable reason do you have for requesting an exemption: *
Which acceptable reason do you have for requesting an exemption:

Course Name *
Course Name

Instructor Name *
Instructor Name

Any other information you wish to provide *
Any other information you wish to provide