Absence and Leave Form

Absence & Leave Request Form
Student Name

First NameLast Name
Grade
Length of Absence

I understand that
My child
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason
Select All Missed Periods

Period	Monday-Thursday	Friday
1	8:05 - 8:55	8:05 - 8:40
2	9:05 - 9:55	8:50 - 9:25
3	9:55 - 10:45	9:25 - 10:00
4	10:45 - 11:35 (boys) 11:35 - 12:25 (girls)	10:00 - 10:35
5	12:25 - 1:15	10:35 - 11:15 (boys) 11:15 - 11:55 (girls)
6	1:40 - 2:30	11:55 - 12:30
7	2:30 - 3:15	12:30 - 1:05

For an absence of up to three school days, students are responsible for making up all missed assignments, quizzes, and tests. Missed work must be completed within the same number of school days as the absence (e.g., two days absent = two school days to complete missed work after returning).
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
***** End Date cannot be before Start Date*****
Reason

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 should 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
***** End Date cannot be before Start Date*****
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.

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

Cancelof
Parent Name

First NameLast Name
Parent Email
example@example.com
Parent Signature
Type of Leave

Should be Empty: