Pre-arranged Absence Request

Absences of more than four (4) days must be approved by the principal or the principal's designee and the student must pick up an extended absence form from Student Services. This form is to be signed by all teachers and must be turned back in to Student Services and approved at least a week before the absence begins.

Students may make up any and all assignments, tests or related work assigned on the day(s) of the excused or unexcused absence at full credit. The student is responsible for asking the teacher(s) for make up tests, assignments and other work. Unexcused absences will still be counted towards Loss of Privileges, including suspension or revocation of parking privileges. Please see the Student Code of Conduct for more information. (Source: Portion from the District School Board of Pasco County Secondary Student Code of Conduct.)

Student Name Student Name First Last
Student Number
Maximum of 6 digits allowed. Currently Entered: 0 digits.
Grade

Grade 9th 10th 11th 12th
First day of absence First day of absence / MM / DD YYYY
Last day of absence Last day of absence / MM / DD YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Phone where you can be reached during the day. Parent/Guardian Phone where you can be reached during the day. - ### - ### ####
Parent/Guardian Email
Reason for Absence
Brief Description
Upload Documentation

Attach Files
Parent/Guardian, please draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Spam Protection. Please answer this simple question:
2, 40, 8, 1 : which of these is the largest?