Educational Excuse Request Form

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New Covenant Christian School
Educational Excuse Request Form
This form is required for absences of three (3) or more consecutive school days
and must be submitted at least five (5) days prior to the beginning of the absence.
Parents complete Section 1.
SUBMIT TO OFFICE.
One form is required per student.
Student name: _________________________________________________
Grade: __________
Dates of proposed absence: ___________________________________________________________
List Teacher(s):
Grades K4 – 5, Homeroom ____________________________ Grade 5 Math: _____________________
Grades 6 – 12, Bible: ________________________
Spanish: ______________________________
History: ___________________________________
Language Arts: _________________________
Science: __________________________________
Math: _________________________________
Jr/Sr Academic Electives: _______________________________________________________________
Student receives Supplemental Support Services (circle one):
yes
no
List in-season Sports/Athletic involvement affected by this absence: _____________________________
Brief description of trip (include location): ___________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Educational benefits of the trip: __________________________________________________________
____________________________________________________________________________________
Parent’s primary phone number: __________________________ Work #:________________________
Parent’s printed name: _________________________________________________________________
Parent’s signature: ___________________________________________ Date: ___________________
The administration and teacher(s) involved will evaluate the effect such an absence would have on
the academic success and progress of the student.
Guidelines for Excused Absences for Students Taking Non-School Educational Tour or Trip
1. This form must be submitted to the school a minimum of five days prior to the trip (except in an emergency).
Parents/Guardians will be notified in any case in which the request is denied.
2. No more than five school days per student will be approved for educational trip/tour requests in any school
year. (Special requests with unusual circumstances or exceptional opportunities for learning should be
discussed personally with the principal well in advance of the requested dates for absence.)
3. Unless there are extraordinarily unusual or emergency circumstances, such requests will NOT be approved
during 4Sight testing (dates on school calendar), when a student has accumulated an excessive number of
unexcused absences, or when the student is in academic jeopardy.
4. All schoolwork missed during the trip/tour must be made up at the initiation of the student immediately upon
returning to school. Teachers are not required to provide work prior to the trip.
5. Days that are not approved for an educational trip are unexcused.

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