Application for Extended Leave/Travel

Note: This form is to be completed by the student's parent and returned to their child's school principal.

STUDENT DETAILS

Last Name *

First Name *

Date of Birth *

Age *

Grade *

Student Address: *

Suburb *

Postcode *

Dates of extended leave/travel applied for:

From: *

To: *

Number of school days: *

Reason for travel: *

Reason travel is occurring in school term: *

DETAILS OF PRIOR EXEMPTIONS or EXTENDED LEAVE/TRAVEL (if applicable)

Date of prior exemption/extended leave:

From:

To:

Number of school days:

Certificate of prior Exemption or Extended Leave/Travel attached:

YesNo

PARENT DETAILS

Family Name: *

Given Name: *

Relationship to Student: *

Parent Address (same as student)? *

YesNo

Parent Address:

Phone Number: *

Parent Email: *

DECLARATION:

As the parent and applicant, I hereby apply for a "Certificate of Extended Leave/Travel" and understand my child will be granted a period of extended leave upon acceptance by the principal of the reason provided.

I understand that if the application is accepted:

I am responsible for his/her supervision during the period of extended leave
The provided period of extended leave is limited to the period indicated
The provided period of extended leave is subject to the conditions listed on the "Certificate of Extended Leave/Travel"
The period of extended leave will count towards my child’s absences from school.
I understand that this leave application is separate from the College's assessment processes. Secondary students impacted by leave will need to follow the processes outlined in the relevant assessment policy to apply for consideration relevant to any impacted tasks.

I declare the information provided in this application is, to the best of my knowledge and belief, accurate and complete. I recognise that should statements in this application later prove to be false or misleading any decision made as a result of this application may be reversed. I further recognise that a failure to comply with any condition set out in the Application for "Extended Leave/Travel" may result in the provided period of extended leave being cancelled.

Signature of Parent: *

Clear

Date signed: *

Relevant travel documentation such as an e-ticket or itinerary (in the case of non-flight bound travel within Australia only) must be attached to this application.

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OFFICE USE ONLY

To be completed by the Principal

I accept this application for extended leave *

YesNo

Please provide more detail here (if required):

Principal signature

Principal's name: *

Signature Date: *

Signature file

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Application for Extended Leave/Travel

STUDENT DETAILS

DETAILS OF PRIOR EXEMPTIONS or EXTENDED LEAVE/TRAVEL (if applicable)

PARENT DETAILS

DECLARATION:

** OFFICE USE ONLY **

OFFICE USE ONLY