Churchill Jr. High School

Vacation Pre-Approval Form

(for absences of three (3) or more consecutive days)

This form must be submitted a minimum of three days prior to a trip for approval by the administration.

Today’s Date

Student Name

Student ID Number

Telephone

Please list the dates you are requesting to be excused from school:

Reason for Leave:

Please note that even with trip pre-approval if you miss 8 or more days in one quarter you can receive no higher than a 2 citizenship in each class.

_________________________________________ _________________ Administrator’s Signature (if approved) Date

It is the responsibility of the student to inform teachers of the dates they will be absent. If teachers are not notified in advance, make up work may not be allowed.