SA2U Class Request Form

School Name *

Address: *

Contact Name *

Contact Title *

Contact Phone *

Contact Email *

Please enter the start and end dates for the term(s) for which you are requesting a class.

	Start Date	End Date
Fall	Start Date	End Date
Winter	Start Date	End Date
Spring	Start Date	End Date
Summer	Start Date	End Date

Time Period Requested - classes must be a minimum of 75 minutes, but most are 90 minutes (i.e. 3:00 - 4:30 PM) *

Please select your top three class perferences below. For each class, select the title, grade range, and day of the week you would like to schedule the class. *Please complete one form per age group.

Class Selection (Choice One) *

Preferred Day* *

Grades *

Class Selection (Choice Two) *

Preferred Day

Grades

Class Selection (Choice Three) *

Preferred Day

Grades

Payment Type *

Grant funded class previously arranged with Saturday Academy

Per class order $165/contact hour (site coordinator registers students and pays one sum to Saturday Academy)

Per student order $155/student/9hr or $165/student/12hr class (parents register students & pay on line via Saturday Academy)

Late-Opening Learning: Per 4-class block $860 (site coordinator registers students and pays one sum to Saturday Academy)

Late-Opening Learning: Per 8-class block $1600 (site coordinator registers students and pays one sum to Saturday Academy)

Paid for with TAG funds $165/contact hour and previously arranged with school district

Per class fee of $100 for use of Saturday Academy computer lab

Please include any feedback, comments, or suggestions here.