1. Elementary Prearranged Absence Form
      1. PARENTS


     
    SCHOOL NAME

    ADDRESS

    Attendance Office: NUMBER

    FAX: NUMBER

    Student #1 Name:   

    Student ID #:   

    Grade:  

    		Student #2 Name:   

    Student ID #:   

    Grade:  

    Student #3 Name:   

    Student ID #:   

    Grade:  

    		Student #4 Name:   

    Student ID #:   

    Grade:  

     


    Elementary Prearranged Absence Form

     


    Families should not schedule vacations or travel while school is in session. If a family vacation or travel must occur while school is in session, it must be prearranged prior to the first date of the absence and approved by the principal (or designee).

     

    Pursuant to district Procedure 3122P, the principal (or designee) may excuse up to five (5) school days for a prearranged absence per student each school year.

     

    Assignments requested for a prearranged absence will be provided to the student or parent/guardian if requested five (5) school days prior to the absence. Please note: Not all learning activities/opportunities can be reproduced outside of the classroom.

     


    Reason for absence:  

       

       

    Date(s) of planned absence:  

    Student #1 Teacher’s name:  

    Student #2 Teacher’s name:  

    Student #3 Teacher’s name:  

    Student #4 Teacher’s name:  

     





    PARENTS

    I have met/communicated with my student’s teacher(s) regarding this planned absence and ways for my student(s) to complete requested assignments. I am aware that this absence may affect my student’s learning and being prepared for the next grade.

     
     

    Parent/guardian signature
     

    Date
     

    Phone
     

    Administrator signature
     

    Date
     

    Number of days excused
     



     


    ****OFFICE USE ONLY****

    Verified by:     Date:  

      q Phone/Fax   q In person   q Email

    Back to top