Agreement Form for Classroom Instruction

Policy Code: 
Adoption Date: 
Tuesday, May 25th, 2004
Review Date: 
Tuesday, May 25th, 2010




                                 Applicant's Name/Agency/Company/Program


Address:  __________________________________________________________________


Phone:  ________________________    Signature__________________________________


By signing above, I/we agree to abide by all of the conditions stated in the Cooperative Agreement with Iron School District. 


Date:  _____________________________.


  1. Attach detailed description of program, including curriculum, film list, schedule, and any other materials to be used.
  2. Attach list of references and any research that may be available to support your program.
  3. Send this completed form with signatures to Iron School District, 2077 West Royal Hunte Drive, Cedar City, Utah 84720.






Principal's Signature



Teacher's Signature                                


By signing above, I/we agree to cooperate and coordinate with  ____________________________________________________


while continuing to actively teach and promote Iron District's K-12 instructional program.


Request Status:               Approved ________                         Not Approved ________



Signature___________________________________________ Date: ________________




Non-Discrimination Statement

Iron County School District is committed to a policy of equal employment opportunity and does not discriminate in the terms, conditions, or privileges of employment on account of race, age, color, sex, national origin, physical or mental disability, or religion or otherwise as may be prohibited by federal and state law.

School District Office

Hours 8 a.m. - 5 p.m. Mon.- Fri.
2077 W. Royal Hunte Dr.
Cedar City, Utah 84720
PH 435.586.2804  FAX 435.586.2815