APPLICATION FORM FOR STUDENT’S LEAVE OF ABSENCE (LOA) For students who will be absent for at least 3 days but not more than 20% of the total school days for the school year

Name of Student: __________________________________________________________ Grade & Section: ________________ Student No. _____________ Contact No: ______________________ INCLUSIVE DATES TOTAL NO. OF SCHOOL DAYS

from ________________ to ________________ ________________ days

REASON FOR ABSENCE ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I have read the Guidelines on Application for Leave of Absence at the back of this page and commit to abide by them. _______________________________________

PARENT’S SIGNATURE above PRINTED NAME

__________________ DATE

-------------------------------Please do not write below this line.-----------------------------Comments and Recommendations: Assistant Principal for Academics [ ] Recommended [ ] Not Recommended ________________________________________________________________________________ ________________________________________________________________________________ _____________________________ FLORA ANNE R. ALFONSO

___________________________ DATE

Grade School Principal [ ] Approved [ ] Disapproved ________________________________________________________________________________ ________________________________________________________________________________ ___________________________ JANE C. CACACHO

____________________________ DATE

APPLICATION FORM FOR STUDENT’S LEAVE OF ABSENCE (LOA) For students who will be absent for at least 3 days but not more than 20% of the total school days for the school year

Name of Student: __________________________________________________________ Grade & Section: _________________ Student No. ____________ Contact No: _______________________ INCLUSIVE DATES TOTAL NO. OF SCHOOL DAYS

from ________________ to ________________ ________________ days

REASON FOR ABSENCE ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I have read the Guidelines on Application for Leave of Absence at the back of this page and commit to abide by them. ___________________________________________ PARENT’S SIGNATURE above PRINTED NAME

__________________ Date

-------------------------------Please do not write below this line.-----------------------------To: The School Registrar Please be informed that the decision on the application for LOA indicated above is: [ ] Approved

[ ] Disapproved

Remarks: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ______________________ Jane C. Cacacho ______________________ Date

Date: ________________________ Dear Mr. and Mrs. _____________________________, Please be informed that your application for a LEAVE OF ABSENCE from _______________ to _______________for your son, _________________________________ of Grade __________ is: [

] APPROVED ________________________________________________________ ________________________________________________________

[

] DISAPPROVED ________________________________________________________ ________________________________________________________

Please be guided by the GUIDELINES FOR STUDENTS’ LEAVE OF ABSENCE found at the back of this page. Thank you. Sincerely, ______________________ Grade School Principal ---------------------------------------------------------------------------------------------------GSPO Copy: Result of Application for Leave of Absence Name of Student _________________________________ [

] Approved

[

Grade & Section _________

] Disapproved

Remarks: _____________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Received by:

_______________________________ Signature over Printed Name

____________________ Date

GUIDELINES FOR STUDENTS’ LEAVE OF ABSENCE What is a LEAVE OF ABSENCE? Leave of Absence (LOA) is a special privilege granted to a student for the following reasons: 1) sickness or 2) participation in an out-of-campus activity as an official delegate of Xavier School. A student who is granted an LOA is expected to assume responsibility for missed school work and requirements due for completion during his leave. In general, all other prolonged absences are considered UNEXCUSED. Therefore, students who are not granted an LOA will not be entitled to any make-up tests/activities which he will miss in his absence. The number of school days filed for LOA must not exceed the Department of Education’s maximum limit. The school, however, still reserves the right to specify the duration of the leave. What is the process in applying for LOA? 1. 2.

Parent/Student goes to the GS Principal’s Office to get an APPLICATION FORM FOR STUDENT’S LEAVE OF ABSENCE. Parents should submit to the GSPO the duly accomplished form together with the necessary documents; i.e., medical certificate from the attending physician, etc.

What should parents do when their son fails to come back on the expected date of return? 1. 2.

3.

The parents should notify the school, in writing, stating the reason for their son’s inability to report to school and the expected date of return from extended leave of absence. On the day the student reports back to school (after the extended leave), he should submit pertinent documents and his parent’s/guardian’s excuse letter to the Grade School Principal’s Office (GSPO). Failure to present satisfactory documents or adequate reason for the extended leave will warrant disciplinary sanction and may forfeit his opportunity to be given makeup tests and activities in which case he may receive a grade of F for such assessment/activity. The school will determine whether or not to re-admit the student and to which year grade he will be re-admitted in the event that the student exceeds the number of allowed absences by the Department of Education.

What happens when parents fail to inform the school about an extended leave? It will be presumed that the student is no longer coming back. His name will then be automatically dropped from the students’ list on the second week from the expected date of return or after he consumes the maximum number of absences allowed by the Department of Education; i.e., 20% of total number of school days, whichever comes first.