Admin

PEAK Program Petition Form

Name of student__________________________________________________________

Date of birth _______________________ Age____________ Grade _________________

 

School ______________________________ Teacher ______________________________

Petitioner _________________________________ Date of request __________________

 

I am requesting that the above named student be considered for admittance into the PEAK program. The reasons I am making this request are as follows:

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Attach additional sheets as needed and return completed petition to:

Dr. Gloria Shamanoff Northwest Allen County Schools

13119 Coldwater Road

Fort Wayne, IN 46845