Form from: St Michael and All Angels

Absence will not be authorised where attendance is lower than 96%  

This request must be completed prior to the leave taking place  

Absence cannot be authorised during statutory assessment periods

Child/ren's name

Current class/es

Age of the child/ren when the absence would occur

Reason for request

Last day in school

Date returning to school

Total number of school days absent (including INSET days)

TO BE COMPLETED BY STAFF

Percentage attendance prior to absence ............................................................................................................................................... 

Number of sessions of unauthorised absence in previous academic year  ................................................................................

Number of sessions of unauthorised absence in previous 10 weeks  ..........................................................................................

Any previous penalty notice details   ........................................................................................................................................................

Any other significant information ...............................................................................................................................................................



.........  Authorised - The request has ben authorised for the following dates  ..... / ..... / ..... to ..... / ..... / .....

.........  Unauthorised - The request for leave of absence during term time has not been authorised because ...............

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