Instructor Meeting Request

Your name: _____________________________________________ Today’s date: ________________

Phone number: _________________________ E-mail address: ________________________________

HR teacher: _______________ Name of instructor requested: __________________________________

Please describe the issue you wish to discuss with the instructor:

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Please list the days and times you would be available to meet with the instructor:

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Place completed form in the Music Office mailbox. The instructor requested will contact you.

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This portion to be completed by instructor

Date and time of meeting: ______________________________________________________________

Result of meeting:

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Your signature: _______________________________________________ Date: _____________

Instructor signature: _______________________________________________ Date: _____________

Third party signature: _______________________________________________ Date: _____________