Lake Placid Middle/High School

Request for Educational Leave

2016-2017

 

The LPMHS Educational Leave Program is designed to support student-athletes academically while they are training and competing at the state and/or national level.  Students interested in participating in this program must fill out this document and turn it into Mrs. Hammaker a minimum of five school days prior to the planned leave.  Students being considered for Educational Leave must maintain an 80% average or above in all classes, hand in their paperwork five school days prior to their leave and receive approval from their principal: Ms. Theresa Lindsay or Mr. Dana Wood.  Student- athletes who are approved and excused for the Educational Leave Program will receive help in getting missed work from their teachers, credit for missed work, and an excused absence on their school attendance record.

 

Student’s Name:_______________________________________         Today’s Date:______________________________

 

Student’s Cell Phone Number: __________________________________________________________________________

 

Student’s Email Address: ______________________________________________________________________________

 

Dates the student will be out of school:                                      From____________________________________

(ie. Tues., 10/20- Fri., 10/23)

                                                                                                                                                                            To_______________________________________

Where will the student be going?:

___________________________________________________________________________________________________

___________________________________________________________________________________________________

 

___________________________________________________________________________________________________

 

What is the name of the competition? (Please specify if it is a state or national):

__________________________________________________________________________________________________

 

__________________________________________________________________________________________________

 

_________________________________________________________________________________________________

 

Coach’s Name: __________________________________

 

Coach’s Phone Number: ___________________________

 

Coach’s Email: __________________________________

 

Parent/Guardian signature:_________________________

 

Parent Phone Number: ____________________________

 

Parent Email:____­­­­­­­________________________________

 

Please return this form to Ms. Amy Spicer, Educational Leave Coordinator, five school days prior to your requested leave.  Failure to follow these guidelines could result in denial of your educational leave.  If you have any questions, please contact Ms. Spicer: aspicer@lpcsd.org

 

____________Approved  ___________Not Approved                         ____________________________________

                                                                                                              Principal’s Signature

 

Reason for denial:_____________________________________________________________________________

_____________________________________________________________________________________________