Absence and Extended Leave Request Form

Absence and Leave Request Form
Student Name*

First NameLast Name
Grade*
Type of Leave/Absence*
Absentee Notification
Please use this option to report absences of 1 to 3 days, including partial days. For absences longer than 3 days, please select "Extended Leave." Please submit this form before the student arrives to school.
Start Date of Absence*

MonthDayYear
End Date of Absence*

MonthDayYear
Reason*
Parent Signature*

Clear
Attachments, if necessary (e.g., a doctor's note)

Cancelof
Extended Leave
Students are allowed a maximum leave period of up to two weeks under this policy. During the extended leave, no make-up work will be assigned. Upon returning, students can make up any missed tests within the first week. All other missed assignments during the leave period will be excused. After the two weeks, no make-up work or tests will be allowed.
Start Date of Leave*

MonthDayYear
End Date of Leave*

MonthDayYear
Number of Days*
Please enter the estimated number of school days your child will be on leave.
Reason*
I accept
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Signature*

Clear
Attachments, if necessary (e.g., a doctor's note)

Cancelof
Should be Empty:

Absence and Leave Request Form