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THE JOHN J. DRISCOLL SCHOOL Public School 16 80 Monroe Avenue Staten Island, NY 10301 Main Building Voice: (718) 447-0124 Fax: (718) 447-5398

Vincenza Gallassio, Principal Rita Diaz-Maniglia, Parent Coordinator (347) 563-4684 (Cell)

Academy Voice: (718) 448-6129 Fax: (718) 448-2533 Frank Campagna, Asst. Principal Caroline Conevery, Asst. Principal

PREPARATION PERIOD CHANGE REQUEST FORM

Dear Ms. Gallassio or Ms. Conevery: I wish to change my prep period with Teacher ___________________ of Class_____ Reason for Request:______________________________________________________ _______________________________________________________________________ Teacher’s Name Requesting Change: ____________________Class:______________ Date of Change:_______________From Period:______ To Period:_______________ Signature of Teacher Requesting Change____________________________________ Signature of Teacher (change was made with)_________________________________ Signature of Cluster Teacher_______________________________________________ Approval of Supervisor __________________________________________________

Please have the above signed by all teachers and respective Supervisor and return to Paula Marino in Main Office


RequestFormChangeofPrep