SEVIER COUNTY SCHOOL SYSTEM

FAMILY VACATION REQUEST (This form is to be used for requests that exceed five school days.) 1. 2. 3. 4. 5. 6. 7.

This form must be processed in advance of the family vacation. The principal may excuse one vacation request per year up to five school days. More than five school days per school year must be excused by the designee of the Sevier County Board of Education in advance of the family vacation or trip. The student is responsible for all missed assignments. This form must be completed for each student. It is the responsibility of the school principal or his/her designee to fax this form to (865) 774-4562. A response to the parent request will be faxed back to the school office by the Director of Curriculum and Instruction. (Sevier County Board of Education Policy 621)

THE PARENT WILL COMPLETE THIS SECTION: Student _________________________________ Homeroom Teacher ____________________ Specific school dates to be missed: _____________________________________________________ Explain briefly why this vacation has to occur during the school year:

_______________________ Date

_______________________________ Signature of Parent

THE TEACHER WILL COMPLETE THIS SECTION: Days absent this year

____________

Briefly summarize this student’s academic achievement/grades:

_______________________ Date

_______________________________ Signature of Teacher

THE PRINCIPAL WILL COMPLETE THIS SECTION BY MARKING ALL THAT APPLY: ( ) Approved for excused absences, up to five days ( ) Not approved for excused absences ( ) Recommended approval of more than five days as noted on parent’s request _______________________ Date

_______________________________ Signature of Principal

CENTRAL OFFICE ACTION: ( ) Approved for excused absences, over five days ( ) Not approved for excused absences

_______________________ Date

_______________________________ Signature of Director of C & I