Pre-Approved Absence Request For Extenuating Circumstances Form
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1ANCHORAGE SCHOOL DISTRICT
Pre-Approved Absence Request for Extenuating Circumstances
Form must be submitted at least one week prior to the absence. Complete one form for each student.
Contact Information
_____________________________________ _________________________________ ______ ____________________
Student last name
Student first name
MI
Teacher
_____________________________________ _________________________________ ______ ____________________
Parent/Guardian last name
Parent/Guardian first name
MI
Student grade level
Primary phone contact ________________________________ Additional contact number ____________________________
Attendance Policy
The principal or designee may excuse a student for temporary absences when receiving satisfactory evidence of illness or other
acceptable reasons. The following conditions may result in an excused absence from school:
1. Illness,
2. Death or serious illness in the immediate family,
3. Participating in a school function,
4. Attendance at religious services, or
5. Extenuating circumstances approved by the principal.
Excused Absence Request
I am requesting permission for my child’s absence to be excused for the following extenuating circumstances:
Dates of absences
Elementary
Number of absences in current semester _________________
From _________________ To _______________________
Secondary
Number of missed school days in absence request: _________
Highest number of absences in a class ___________________
Parent/Guardian Acknowledgement
I acknowledge that these absences may jeopardize my child’s academic progress.
Parent/Guardian signature _________________________________________________________ Date _________________
Principal/Designee Consideration of Request
_____ I approve this as an approved absence
_____ I do not approve this as an excused absence. It will be marked as unexcused.
A copy of the completed request with principal/designee signature is provided to the parent/guardian. If the pre-approved absence request is denied, the
parent/guardian may have that decision reviewed by making a request to the appropriate division within two school days.
Principal comments
Principal/Designee signature _______________________________________________________ Date _________________
Make-up work
When a family knows in advance that their child will be absent from school for five or more days, a separate class work make-up
request can be made through the school office.
Copy to:
_______Principal
_______Office
_______Teacher
_______Parent
_______Other
HIG-1259 (Revised o9-13)
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