Application for Planned Leave from School
Please fill out this form to request leave of 3-10 school days.
For leave of 1 or 2 school days please contact your home room teacher directly.
Email address *
Student name(s) *
Your answer
Grade(s) *
Required
Homeroom teacher(s) *
Your answer
Student(s) will be away from this date *
MM
/
DD
/
YYYY
Student(s) will be back at school on this date *
MM
/
DD
/
YYYY
Total number of school days, that will be missed *
Purpose of leave *
Your answer
NOTE: It is your child's responsibility to liaise with all subject teachers before and after their period of absence in order to ensure that s/he is up to date with all their school work. What range of strategies will be used to ensure that the student(s) keep up-to-date during the absence? What strategies will your child use while away to strengthen their academic skills? *
Your answer
Your name, to serve as a signature *
Your answer
The decision from the school will be sent to the email address listed above. Remember: it is the student's responsibility to contact all their teachers ahead of time and agree on how to keep up-to-date with school work.
A copy of your responses will be emailed to the address you provided.
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