Request for leave of absence from The Academy during term time
www.langleyacademy.org
Name of Student:
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House Tutor Group:
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Year Group:
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Date leave requested From :
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Month
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Day
Year
Date
Date leave requested To :
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Month
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Day
Year
Date
No of Days:
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I request this leave to be granted for the following exceptional reason:
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In the case of a holiday or trip, please explain below the factors which make the circumstances of your request exceptional.
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Signature of Parent/Carer:
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E-mail address:
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Date:
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Month
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Day
Year
Date
For School Use Only
Number of Authorised Absences:
Number of Unauthorised Absences:
Number of Late Arrivals:
Evidence Supplied:
Yes
No
Absence Authorised:
Yes
No
Signed
Date:
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Month
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Day
Year
Date
I confirm I have read the details on the attendance page of the Academy website and I am aware that if this request is for 5 or more days and has been unauthorised by the Principal then it will be referred to Slough Borough Council YES
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true
Submit
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