JED-AR - Request for an Excused Pre-arranged Absence

PARENT’S NAME (PRINT)                                                                                                                             

ADDRESS                                                                                                                                                        

TELEPHONE (H)                                                                    (w)                                                                     

 

CHILD(REN) NAMES                                         GRADE             SCHOOL

                                                                                                                                                                      

                                                                                                                                                                      

                                                                                                                                                                      

                                                                                                                                                                      

                                                                                                                                                                      

 

DATES OF THE ABSENCE(S)            /           /           THRU             /           /          

REASON FOR THE ABSENCE:                                                                                                                     

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

(WRITE ON BACK IF NECESSARY)

 

                                                                                                            /           /          

            PARENT SIGNATURE                                                          DATE

 

(To be filled out by the building principal)

 

               I am approving/recommending your request for approval.

 

               Your request has been denied for the following reason(s):

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                        /           /          

            (Signature of Principal)                                                                  (Date)

 

(To be completed by the Superintendent if the request is for more than five days.)

               I am approving/recommending your request for approval.

               Your request has been denied for the following reason(s):

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

                                                                                                                                                                          

 

                                                                                                                            /           /          

(Signature of Roseburg Public Schools Superintendent)                  (Date)

JED-AR: Request for Excused Pre-arranged Absence