Application for Extended Leave

Application for Extended Leave - Vacation/Travel
Student Details
Please list all students associated with this period of leave (please use the 'Add another student' button below if you have multiple students)
Will the student's listed above be in Primary or Secondary at the time of travel?
Student's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Details/Date of extended leave applied for:
Start Date of extended leave

DayMonthYear
Date
End Date of extended leave

DayMonthYear
Date
Number of school days
Reason for travel
Please upload relevant travel documentation such as an e-ticket or itinerary (in the case of non-flight bound travel within Australia)

Cancelof
Details of previous Exemptions for Extended Leave - Vacation/Travel
Have any of the students listed above received previous exemptions from school for Extended Leave - Vacation Travel?
Date of prior exemption/extended leave From Date* to End Date*.
Total number of school days No. of days* they were absent.
Please upload a copy of the previous Certification of Exemption/Extended Leave - Travel

Cancelof

Parent/Carer Declaration
Declaration
I understand that if the application is accepted: (please tick all to acknowledge understanding)
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 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 - Vacation/Travel may result in the provided period of extended leave being cancelled.
Signature of parent
Date signed

DayMonthYear
Date
Should be Empty:

Application for Extended Leave - Vacation/Travel