PLANNED ABSENCE FORM

Name of Student:

Grade:

To be filled out by Parent/Guardian:

The student will be absent from school beginning (date)

at (time)

and will return to school on (date)

at (time)

Purpose for absence:

Will student be able to do school work while away from home?
Date

Parent/Guardian Signature

AFTER OBTAINING PARENT/GUARDIAN APPROVAL, IT IS THE STUDENTS RESPONSIBILITY TO RECEIVE

APPROVAL FROM MR. NEELY.
To be filled out by Dean of Students:
Signature of Dean of Students

__Date

_____________________________________________________________________________________________
Name of Student______________________________________

Date of Absence ______________________________

Signature of Dean of Students _________________________________________ Date _____________________________

TO BE SUBMITTED TO TEACHERS FOR ASSIGNMENTS AT LEAST 2 DAYS IN ADVANCE.

CLASS:

Teachers Signature:

Assignments/Special Instructions :

CLASS:

Teachers Signature:

Assignments/Special Instructions :

CLASS:

Teachers Signature:

Assignments/Special Instructions :

CLASS:

Teachers Signature:

Assignments/Special Instructions :

CLASS:

Teachers Signature:

Assignments/Special Instructions :

CLASS:
Assignments/Special Instructions :

Teachers Signature: