Notification of Student Extended Absence from School

Prior to completing this form, please ensure you have read this important information from Mr Jeff Sochacki, R-12 Deputy Principal:
Letter to Parents/Caregivers
This form is to be completed for absences of one week or more for family travel/holiday (up to 12 months), medical (up to one month) or other conditional/ongoing absence. You can advise of extended absence for more than one child using this form.

Hidden
Form Admin Email P*
Hidden
Form Admin Email S*
Compulsory Information
Name of Student 1 In Full*
Mentor Group/Class Teacher(s)*
Year Level*
In Middle and Senior years we expect that students will:
- inform their subject teachers of the absence
- ensure they are aware of the topics/concepts they are missing in any summative assessments
- where possible, complete work to keep up to date with the learning plan
- negotiate any extension for summative assessment where applicable through the correct protocols.
Student's Date of Birth*
DD slash MM slash YYYY
Student's Age*
Parent/Guardian Phone*
Absence start date*
DD slash MM slash YYYY
Absence end date*
DD slash MM slash YYYY
Reason for Absence*
Please provide deatils*
Additional Students
Do you have other child/ren that will be absent on the same days?*
- Yes
- No
Please specify*
- 1 additional
- 2 additional
- 3 additional
- 4 additional
- 5 additional
Student 2 Information
Name of Student 2 In Full*
Year Level*
Mentor Group/Class Teacher(s)*
Student 3 Information
Name of Student 3 in Full*
Year Level*
Mentor Group/Class Teacher(s)*
Student 4 Information
Name of Student 4 in Full*
Year Level*
Mentor Group/Class Teacher(s)*
Student 5 Information
Name of Student 5 in Full*
Year Level*
Mentor Group/Class Teacher(s)*
Student 6 Information
Name of Student 6 in Full*
Year Level*
Mentor Group/Class Teacher(s)*
Parent / Guardian information
Name of Parent/Guardian*
Parent/Guardian Email*
Enter Email Confirm Email
Parent/Guardian Signature*

Notification of Student Extended Absence from School

Compulsory Information

Additional Students

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Student 6 Information

Parent / Guardian information