Absence Request

This form may be used to EXCUSE an absence or, it may be used to REQUEST APPROVAL for a future absence. A separate form must be completed for EACH absence, unless they are consecutive and for the same reason.

Example:
"My child was absent for 2 days due to illness." This may be submitted on ONE form.
"My child was absent Monday due to illness and Thursday for a college visit." This requires TWO forms.

Today's Date

Date

Parent or Guardian Name*

First NameLast Name

E-mail*

An email confirmation will be sent to this address.

Student Name*

First NameLast Name

School Building*

Student's Grade

This submission is:*

Sibling(s):*

Does your child have a sibling(s) that attend LVA? If so, please complete a form for each child.

Type of Absence:*

If this is an Educational Trip (Vacation) please check which item applies:*

We are traveling within the United StatesWe are traveling to another Country other than within the United States (Please be aware that if you travel anywhere that has restrictions due to Covid, you are expected to follow whatever the posted guidance is from the CDC for international travelers before your child returns to school (Quarantine, testing, etc).

Additional Information (Please share reason for the absence)

Requests for Educational Trips or Tours must be submitted at Least Ten (10) School Days Prior to Trip/Tour. You will receive an e-mail indicating if your request has been approved.

Excuse notes can only be accepted if they are submitted within 3 school days of the child's return to school. If you have a doctor's note, it can be sent in with your child, or attached below as a PDF from your computer or a photo from your computer or mobile device. If this absence was beyond 3 school days from your child's return to school, it will only be accepted as an excuse if a doctor's note or other official documentation is attached.

Doctor's Note or Other Documentation, if applicable.

First Date of Absence*

Last Date of Absence (for absences of 2 or more CONSECUTIVE DAYS)*

Date Your Child Returned to School From This Absence

Date

It appears as though this excuse is for an absence that was more than 3 days after your child's return to school. Please confirm your child's return to school date or, this absence will remain as UNEXCUSED.

For Administrative Use Only
Requests for Educational Trips or Tours must be submitted at Least Ten (10) School Days Prior to Trip/Tour. You will receive an e-mail indicating if your request has been approved.

Absence Request Form