Instructions for Obtaining a Work Permit

  • During the school year, forms can be returned to:
    Peggy Drexler or Melissa Koetzle in Counseling College and Career Center.

    During the Summer forms can be returned to:
    Community Education 
    200 Alcott Rd.
    Rochester, NY 14626
    Phone:  585-865-1010


    Complete Part I (Parental Consent)

    • Date
    • Applicant Name
    • Age
    • Address
    • Parent/Guardian Signature

     Complete Part II (Evidence of Age)
         Bring with you the following
            (copies are acceptable)

    • Proof of Age (Birth Certificate)
    • Driver’s License or Learner Permit

    Complete Part III (Certificate of Physical)

    • Must be completed by school nurse or physician

Work Permit Forms