Grayling Middle School Pre-Arranged Absence Form

Pre-arranged absence forms must be completed, including teacher recommendations and parent and administrative approval, in order to insure and excused (no count) absence.  

Pre-arranged Absence Request Forms must be completed and turned into the office at least five (5) school days prior to the absence(s) to be considered. Note: A student may request up to a maximum of five (5) pre-arranged school days in any one (1) school year.

_______________________________      ________    ________________    ________________________________________________________________________________

Student’s Name-Please Print                     Grade            Today’s Date                                                     Proposed date(s) to be absent from school

Reason:________________________________________________________________________________________________________________________________________

I understand that I must complete assignments missed                                                                I understand that any absence potentially affects classroom

while I am gone, either before I am absent or after I return                                                        performance and acknowledge my child’s responsibility to

depending on my teacher’s request.                                                                                Obtain and make up all work missed.

Student’s Signature_________________________________                                                        Parent’s Signature___________________________________

HOUR

TEACHER’S SIGNATURE

CLASS

NO. OF ABS/TARDIES TO DATE

RECOMMENDATION & REASON-MUST PROVIDE A REASON IF NOT RECOMMENDED

COMPLETION

Before/After

ASSIGNMENT GIVEN

1

__Recommended               __Not Recommended

Reason:

2

__Recommended               __Not Recommended

Reason:

3

__Recommended               __Not Recommended

Reason:

4

__Recommended               __Not Recommended

Reason:

5

__Recommended               __Not Recommended

Reason:

6

__Recommended               __Not Recommended

Reason:

Approved ___        Denied___                        Principal Signature______________________________________    Date____________________