ACT 1776

Exhibit G

Name: _____________________________

Summer Address and phone # if necessary

Adress: ______________________________________

Phone: _______________________________________________________________________

Department: ______________________________________________________________

A) List Preference of Subjects You Would Like to Teach Next Year:

Grade(s) Course(s) Track(s)

1) _______________________________________________________________

2) _______________________________________________________________

3) _______________________________________________________________

B) Indicate your preference for service period:

C) If assigned a homeroom, what is your preference for year:

Freshman ____ Sophomore ____ Junior ____ Senior ____

D) Special Request(s): ___________________________________________________

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Teacher's Signature _____________________ Date ____/____/____

* Please return this form to your department head(s) by _________________
* Each teacher is advised to keep his/her own copy of this form.

Department Head's Recommendation: ____________________________________________

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Department Head's Signature ________________________ Date ____/____/____

Teacher's Signature ___________________________ Date ____/____/____

The needs of the school shall take precedence over the Preference Form.