PREARRANGED ABSENCE FORM - Griffith Public Schools

Area Career Center (Hammond)
5727 Sohl Ave Hammond, IN 46320
Office (219) 933-2428
Fax (219) 554-4570
PREARRANGED ABSENCE FORM PARENT/GUARDIAN We hope that you have carefully considered any affect this absence may have on your child’s success in school. In order for this absence to be considered, this form must be completed and submitted to the ACC Attendance Secretary at least 48 hours prior to 1st day of absence. Please note: It is your son/daughter’s responsibility to arrange for completion of all work missed during this absence. Student Name: ___________________________________________________ Date: ___________________________ Grade: 11 / 12 ACC Program: ________________________________________________________ AM / PM I am requesting that my son/daughter be allowed to be absent from school From: ______________________ to: ______________________ for a total of __________school days. (Date) (Date) Provide a detailed description/reason for this absence: _____________________________________________________ __________________________________________________________________________________________________ Parent Signature: ________________________________________________ Phone: __________________________ ACC TEACHER ACKNOWLEDGEMENT Absences to Date: ____________________ Class: ____________________________________________________________ Requested Absence: ___Recommended ___Not Recommended Teacher Signature: _________________________________________________ Date: ___________________________ Homework Assignments: _____________________________________________________________________________ __________________________________________________________________________________________________ HOME SCHOOL ADMINISTRATOR Administration is aware of request for excused absence and will give approval or denial based on the recommendation of the teacher(s) on the completed form above. Requested Absence: ___Recommended ___Not Recommended Administrator Signature: ___________________________________________ Date: ___________________________ ACC ADMINISTRATOR Requested Absence: ___ Approved ___ Not Recommended Administrator Signature: ___________________________________________ Date: ___________________________ ACC Attendance Secretary Date form was returned: ______________________ Initialed: _____________________ Student Attendance Report Attached