Report an Absence
Submitting this form will alert the office at Dixon-Smith Middle School that your child is absent. It will also serve as an excuse note for the absence. For multiple days absent please fill out the NOTE section at the end of this form. This must be completed within 5 days after your student returns to school.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Grade Level *
Date of Absence *
MM
/
DD
/
YYYY
Please provide a reason for this absence. *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian email address *
Your answer
Parent/Guardian Contact Phone Number xxx-xxx-xxxx *
Your answer
Notes for reporting multiple absences
Your answer
I certify that I am the parent or legal guardian of this student and am authorized to submit this information. *
Submit
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