Name of Person Completing Form
First Name
Last Name
Are you a(n):
*
Student
Advisor
State Staff
Other
Email Address of Person Completing Form
*
example - advisor@school.net
Cell Phone Number of Person Completing the Form
Format: (000) 000-0000.
Name of Student with Scheduling Conflict
*
First Name
Last Name
Chapter Name of Student with Scheduling Conflict
*
Chapter Name
Chapter ID of Student with Scheduling Conflict
*
Chapter ID - example IN0001
Please select Award Area(s) of Student with Scheduling Conflict(s).
*
Agriscience
American Star
CDE/LDE
National Chapter
National Officer Candidate
Official Delegate
Proficiency
Band
Chorus
Talent
Other
Day(s) of Conflict
*
Wednesday, October 30
Thursday, October 31
Friday, November 1
Other
Describe in detail the potential scheduling conflict for student mentioned above.
*
Example - Jane Doe is competing in Animal Science D3 and Beef Proficiency.
Submit
Should be Empty: