Request For Excused Absence

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1. Read the form thoroughly and complete all information requested.

2. Please fill out the form 2 weeks prior to the requested absence.

3. The school will notify your family whether the request has been approved as an excused or unexcused absence.

Note: Even if today's date is less than 2 weeks before the absence, please complete the form; it is very helpful in planning for your child.

Student Name: *

Grade: *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Seventh Grade

Eighth Grade

Other:

Required

Todays Date: *

YYYY

Your email address: *

First Day of Absence: *

YYYY

Date your child will return to class: *

YYYY

Check circumstances that apply: Unexcused Absences:

Short-term Family or Personal Occasions and Obligations

Weddings, Reunions, Birthdays, Anniversaries

Extracurricular Tutoring and Enrichment

Excused Absences:

Awards and Commendations, Graduations

Short-term and Long-term Illnesses

Religious Occasions and Obligations

High School Visits

Funerals

Family Emergency/Disaster

Other:

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