EDUCATIONAL LEAVE FORM

REQUEST FOR ATTENDANCE EXCEPTION BOE Policy ____________________________ Name of Student

Greenbrier East High School

Date(s) of absence: _____________________________________________________________________ Description of request and reason for absence: ______________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Description of educational content: ________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________ Signature of Student

__________________________ Signature of Parent

If granted, it is the student’s responsibility to keep a daily journal of the experience in order to document the educational content. ………………………………………………………………………………………………………………………………………………………………… We have reviewed this request and feel that it will meet the criteria stated in county policy. Therefore we recommend that this exception be granted. ________________________________ Signature of Principal

________________________________ Signature of Teacher

________________________________ Signature of Counselor

________________________________ Signature of Teacher

________________________________ Signature of Teacher

________________________________ Signature of Teacher

________________________________ Signature of Teacher

________________________________ Signature of Teacher

________________________________ Signature of Teacher

________________________________ Signature of Teacher

_____Accepted __________________________________ Signature of Attendance Dean

_____Denied