RISE CHARTER SCHOOL #562
203 Center Street West Kimberly, Idaho 83341
208-423-4170
Sport Participation Verification Form
For PE Credit Substitution (Policy 2315B)
Academic Year: ___________
Student Information
- Student Name: ___________________________________________
- Grade Level (Circle One): 9 10 11 12
- Sport Participated In: ____________________________________
- Sport Type:
☐ IHSAA-Recognized School Sport
☐ LEA-Approved Club Sport
☐ Community-Based Sport (LEA-Approved)
Participation Details
- Start Date of Participation: ______________
- End Date of Participation: ______________
- Total Duration (Weeks): _______________
(Must be at least 18 continuous weeks; no break >2 weeks if it is a Community Based Sport) - Number of Practices per Week (Average): __________
- Number of Competitions/Games Attended: __________
- Weekly Time Commitment (Approximate hours/week): __________
Coach/Instructor Verification
Coach/Instructor Name: ____________________________________
Organization/Team Name: __________________________________
Phone/Email: _____________________________________________
☐ I verify that the above-named student actively participated in this sport meeting the weekly and seasonal participation requirements as outlined in RISE Charter School Policy 2315b.
Coach/Instructor Signature: ______________________ Date: __________
Student Acknowledgement
☐ I certify that the information provided is accurate and understand that this form is being submitted for review and potential awarding of one (1) semester PE credit.
Student Signature: ____________________________ Date: __________
Parent/Guardian Acknowledgement
☐ I acknowledge my student’s participation and the intent to substitute PE credit through this activity.
Parent/Guardian Name (Printed): ___________________________
Parent/Guardian Signature: _____________________ Date: __________
School Use Only
- Verified by Administrator: __________________________________
- Date Reviewed: __________________
- Approved for PE Credit Substitution: ☐ Yes ☐ No
- Comments: ___________________________________________________
Administrator Signature: _______________________ Date: __________
Please return this completed form to the RISE Charter School front office by the end of the season.