Request For Excused Absence Form - St. Bartholomew School printable pdf download

ST. BARTHOLOMEW SCHOOL – REQUEST for EXCUSED ABSENCE FORM

Please complete this form and submit it the principal at least two days prior to the absence.

Parent/Guardian: ___________________________________________ Date: ______________________

Phone: _______________________________________________________________________________

Email: _______________________________________________________________________________

Student: __________________________________ Grade: _______ Teacher:_______________________

Number of School Days Involved: ____________

Date(s) of Requested Absence: ___________________________________________________________

Describe the reason for this request for an excused absence: ___________________________________

_____________________________________________________________________________________

If applicable, describe any educational objectives or activities you have planned for your child during the

period of absence: _____________________________________________________________________

_____________________________________________________________________________________

Have you previously applied and received approval for an excused absence?

____________No

____________ Yes – then please complete the following:

Date(s):____________________________ Circumstances: _____________________________________

_____________________________________________________________________________________

Parent/Guardian Signature: ___________________________________________________________

For School Use Only (Copy to Parent, Homeroom Teacher, Child’s Permanent Record)

____________Approved

____________Denied

Homeroom Teacher Signature: __________________________________ Date: ____________________

Principal Signature: ___________________________________________ Date: ____________________

Request For Excused Absence Form - St. Bartholomew School