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
2 digit month, 2 digit day, 4 digit year
End Date of Absence

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Reason
Parent Signature
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
2 digit month, 2 digit day, 4 digit year
End Date of Leave

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Number of Days
Please enter the estimated number of school days your child will be on leave.
Reason
I understand that this extended leave may result in my child's grades suffering and my child possibly being retained.
Parent Name

First NameLast Name
Parent Email
example@example.com
Parent Signature
Attachments, if necessary (e.g., a doctor's note)

Cancelof
Should be Empty:

Absence and Leave Request Form