EXCUSED ABSENCE REQUEST FORM
Note: This form must be completed and submitted to the office secretary one week prior to the anticipated absence. (This excludes unanticipated illness and emergencies.) It should be signed in the following order (1) Student, (2) Parent, (3) All instructors whose classes you will be missing.
Student___________________________ Grade______________________
Date(s) of Absence__________________ Total School Days____________
Instructor Signature (for each class to be missed):
Per. 1_____________ Per. 5______________
Per. 2_____________ Per. 6______________
Per. 3_____________ Per. 7______________
Per. 4_____________ Per. 8______________
Reason for Absence (i.e., school-related/school-sponsored, excused travel absence):
_______________________________________________________
_______________________________________________________
_______________________________________________________
Student Signature:_______________________ Date:_______________
Parent Signature:________________________ Date:_______________
