Change in Attendance Request Form

This form must be completed, signed, dated and submitted to the UCLC office a minimum of one (1) month before the requested change is to take place.

Parent/Guardian Name: *

Parent/Guardian UND ID Number:

I am a:

UND Student
UND Faculty/Staff
Community Member

Child's Name: *

My child's current schedule is:

Monday - Friday
Monday/Wednesday/Friday
Tuesday/Thursday

I would like to request the following schedule for my child:

Monday - Friday
Monday/Wednesday/Friday
Tuesday/Thursday

Date I am requesting this change be effective:*

I understand that this schedule is not effective until approved by the director, assistant director, or administrative assistant at which time I will be given a new contract reflecting the new schedule and tuition due.

Yes
No

Parent/Guardian Signature (typed signature ok):*

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