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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)