Bloomfield Jr/Sr High School

Prearranged Absence with Administrative Approval

This form must be completed and returned 5 SCHOOL DAYS in advance of the absence 

Student Name: _________________________     Date:____________

The above-named student will be absent from school on: _____________

Reason for absence:__________________________________________

The student recognizes that it is his/her responsibility to secure all make-up work required by his/her teachers.  A student must be passing ALL classes to be excused for this absence.  Students not passing will NOT be excused to be absent from school. If approved, this is an excused absence and will count toward accumulated EXCUSED absences.

This form should be signed by each teacher so the teacher has prior knowledge of the absence and can plan accordingly.

__ Approved   ____ Denied - Reason_________________________________________