Jordan Valley School District - Home of the Colts

Attention Parents:

The Pre-Arrange form needs to be submitted at least 2 days prior to your students’
absence.

This needs to be approved by Mr. Johnson before the date(s)
of the student being absent.

Pre-Arranged forms can be emailed upon request, or paper
copies pickup at the office.

District Policy states that Pre-Arrange Absences can not exceed 10 days.

1) Date of Request Required*

2) Date(s) of Absents Required*

3) Reason for Absences Required*

4) Student(s) Name Required*

5) Parent Name Required*

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Jordan Valley School District
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Pre-Arranged Absence Request

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Jordan Valley School District 604 Oregon Ave. or Mailing: PO Box 99 Jordan Valley, Oregon 97910-0099
Number: (541) 586-2213 Fax: Fax (541) 586-2568