Absence Request

Absence Request Form

Lehigh Valley Academy
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.

"A student may be excused for up to 10 attendance days per school year. After this period a medical note will be required within the 3rd day of all future absences. "
Today's Date

MonthDayYear
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 outside of the United States.
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.

Upload a File

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First Date of Absence*

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

MonthDayYear
Date Your Child Returned to School From This Absence

MonthDayYear
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.

Absences:________ Days Approved:___________ Principal Signature:______________________
Should be Empty:

Absence Request Form