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Series 604. - Administrative Staffing Summary for Middle School Student Participation in High School Junior Varsity or Varsity Athletic Activities-Gifted Athlete 


Student__________________________________   Date______________________________

School ___________________________________   Grade__________ Sport____________

A.    Options discussed:

B.    The following members of this committee met and considered the above-named student’s request to participate in a junior varsity or varsity level athletic activity.

                        Signature                                           Title

______________________________________      Middle School Principal

______________________________________      High School Principal

______________________________________      Middle School Athletic Director

______________________________________      High School Athletic Director

______________________________________      Middle School Head Coach

______________________________________      High School Head Coach

______________________________________      School Psychologist

C.    We recommend/do not recommend (circle one) that the above-named student be given the opportunity to participate on a junior varsity or varsity level team.

D.    Reasons for recommendation:




Signature of middle school principal


I agree/disagree (circle one) with the committee’s recommendation.


Signature of director of secondary education