G:\Coredata\Office\SLIPFORM\Application For Student Leave.Docx

To apply for student leave please complete this form and submit at the Administration office for a Deputy to review.

If the leave or exemption is approved, the student must arrange for their teachers to complete a Student on Approved Leave – Subject Tasks form (a copy of the approved Application for Student Leave must be attached to the Subject

Tasks form)

If the leave is not approved a copy of the Application for Student Leave must be given to the student to take home.

Application Date:

Student Name:

Student ID:

Year Level:

Leave Start Date: Leave End Date:

Proposed Number of School Days absent:

*If more than 10 days see Application for exemption over page to be completed*

Reason for Leave:

For Office Use Only

Reasonable Code

Code: A - Authorised School Activity F - Off-Campus Activity I - Illness O - Other Reasonable Excuse S - Sport (Representative) W - Work Experience

Not Reasonable Code

Please note that you will not receive daily absence text messages for unapproved leave, but this will be displayed in the Absence Report comments

Exemption Approved

Please note that you will not receive daily absence text messages for this leave. If your student should return early please advise the office immediately.

APPLICATION FOR STUDENT LEAVE

Exempt

For leave of 10 days or less Student to seek work from teachers Deputy Signature:

Date:

Enter into ID Attend

For leave of 10 days or less Student not provided with work from teachers Deputy Signature:

Date:

Enter into ID Attend Assessment penalty for not submitting work

For more than 10 days Type of exemption Not Reasonable (Student not provided with work from teachers) Reasonable (Student to seek work from teachers) Deputy Signature:

Date:

Enter into ID Attend as Exempt Enter student into Attendance Exemption Register in Student Profile on OneSchool

H

G:\Coredata\Office\SLIPFORM\Application For Student Leave.Docx

(Please type or print clearly)

To be completed by the parent and young person

1. Name of student in full

2. Date of birth

4. Name of school MERRIMAC STATE HIGH SCHOOL

5. Year level Compulsory schooling Compulsory participation

6. Name of parents/carers

7. Address

8. Home phone 9. Mobile phone

10. Period for which exemption is sought (insert dates)

From To Up to 1 school year

More than 1 year

11. Reasons for seeking exemption (please provide full details and attach documentary evidence to support this application e.g. statement from medical practitioner)

Signature of parent Date Signature of young person Date (if it is inappropriate for the parent to sign the consent)

Please tick whichever is appropriate: I grant an exemption for this student. I do not grant an exemption for this student. I grant the exemption with the following conditions:

I grant the exemption with the following changes to what has been requested:

________________________________________ ______________________________ Principal’s Signature Date

APPLICATION FOR EXEMPTION FROM SCHOOL FOR MORE THAN TEN DAYS