UCLA Homeschool Study

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Authorization Form
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Sunland
Student applying for concurrent or summer school enrollment must receive approval from their school counselor.
(Print out this form and submit to your counselor.)

To be filled out by high school counselor.

Student Name: __________________________________________

Grade: _______   DOB: ______________________

Courses To Be Taken:

List course title, length - semester (A or B) or year, and which term it is to be accomplished (school year or summer)

Course                                                       Length           Term

_______________________________________________________

_______________________________________________________

_______________________________________________________

School: _________________________________________________

Address: _______________________________________________

City, State, Zip: __________________________________________

School Phone: ___________________________________________

Counselor: ______________________________________________

Signature: ______________________________________________

Date: ______________

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