Religious Leave of Absence Request
Submit a request for a student's religious leave of absence from public education.
Student Full Name
*
First Name
Last Name
Student Grade/Class
*
School Name
*
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Dates of Requested Leave (Start and End)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Days Requested
*
Reason for Religious Leave
*
Please Select
Religious Holiday or Observance
Religious Ceremony or Event
Pilgrimage
Other (please specify)
If 'Other', please specify the reason for leave
Additional Comments (optional)
Parent/Guardian Signature
*
Submit Request
Submit Request
Should be Empty: