4316.E-3, Physical Education Exhibit

Extra-Class Activity Evaluation Form

STUDENT ____________________________________________________ DATE _____________
EXTRA-CLASS ACTIVITY ____________________________________________________
SPONSOR ____________________________________________________
PURPOSE OF EXEMPTION:

RECOMMENDED GRADE ____________________

____________________________________________________
Sponsor’s Signature

Please return this form to Director of Physical Education, Shaker High School, Latham, NY 12110.

Note: Prior exhibit 5125.3(d)