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Exemption Form

exceptin form SA

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15 views

Exemption Form

exceptin form SA

Uploaded by

Test
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM C

Updated: Aug 2023

PRINCIPAL APPROVED APPLICATION FOR EXEMPTION FROM SCHOOL


ENROLMENT/ATTENDANCE AND EDUCATION ENROLMENT/PARTICIPATION
FOR ALL STUDENTS UP TO 17 YEARS
The student must attend school regularly until exemption is approved.
Information provided is protected by section 137 of the Education and Children’s Services Act 2019.
For information regarding the exemption processes see SA.GOV.AU - Exemption from attending school (www.sa.gov.au)

COMPULSORY INFORMATION – all fields must be completed - Please retain at school in student file

Name of Student (in full) EDID

School/Provider Site No:

Principal’s Name

Parent/Guardian Address

Parent/Guardian Phone Postcode

Student’s Date of Birth Age Gender Year Level

GOM Yes / No ATSI Yes /No SWD Yes / No

Name of Parent/Guardian Signature

Principal
TemporaryApproved temporary period of exemption
Period of Exemption

Family Travel/Holiday – Up
to 12 months
(Copy of itinerary/flight booking
Destination
to be kept on school file)

Start Date End Date

Other/Conditional/Part time
– Up to 1 month
(Copy of documentation to be
Destination
kept on school file)

Start Date End Date

Medical – Up to 1 month
(Copy of recent medical support Destination
letter to be kept on school file)

Start Date End Date

Please retain with all relevant supporting documents at school in student file for audit purposes

Print Principal Name: PRINCIPAL – APPROVED / NOT APPROVED


(please circle)

Signature ____________________________ Date____/____/____

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