Student Excused Absence Form

Request for

Student Excused Absence/Family Trip

 

Please complete and return to office at least two weeks prior to your event.

 

Student Name: ___________________________________________________

Dates of Requested Absence: _______________________________________

Destination: __________________________________________________

Reason for the Absence: _____________________________________________________________________________________

_________________                  _______________________________________________

 Date                                                Parent’s Signature

 

 

Teacher Comments:  ___________________________________________________________________________________________________________

 

_____  Absence Approved

_____  Absence Approved with the Following Stipulations: ____________________________

_____  Absence Not Approved

_____________________                  _____________________________________

 Date                                                     Administrator’s Signature