Homework Pass Credit Slip

________________________________ loans to __________________________________
                       (Teacher)                                                                                               (Student)

one, half-hour homework pass.  This pass must be repaid by___________________________.
                                                                                                                (Date)

_____________________________                  _________________________________
             (Teacher signature)                                                                         (Student signature)

Homework Pass Credit Slip

________________________________ loans to __________________________________
                       (Teacher)                                                                                               (Student)

one, half-hour homework pass.  This pass must be repaid by___________________________.
                                                                                                                (Date)

_____________________________                  _________________________________
             (Teacher signature)                                                                         (Student signature)

Homework Pass Credit Slip

________________________________ loans to __________________________________
                       (Teacher)                                                                                               (Student)

one, half-hour homework pass.  This pass must be repaid by___________________________.
                                                                                                                (Date)

_____________________________                  _________________________________
             (Teacher signature)                                                                         (Student signature)