Student Absence Form
Please be advised that this form may only be filled out by the student's parent or guardian, unless the student is their own guardian. If you have questions, please reach out to Anna Heesen by phone: 608-758-6110 or email:
Absences submitted on this form will be considered excused absences. (Note: WI s.118.15(3)(c) states: A child may not be excused for more than 10 days in a school year). Non-notification will result in the absence being counted as unexcused.
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If you do not wish to share your student's name on this form, please simply put the student initials.
If you are a student and are your own guardian, please enter "self."
Reason for Student Planned Absence:
Timeframe of Absence:
If checking "Partial Day" or "Multiple Days" please also check "Other" and explain.
If student will be picked up from school: What day & time?
Departure method of transportation:
If student will be picked up from school by someone other than a parent/guardian, please check the "Other" box and enter the name of the person who will be picking the student up from school. If we find that this person is not on the Approved Visitor List, a staff member will contact the Parent/Guardian to confirm approval. Please contact our Education Office at 608-758-6110 if you have questions. Please also note that WSBVI Charter Bus Transportation only runs on designated transportation days. Please call Andy Soto at 608-758-6159 if you have questions regarding the Charter Bus Transportation schedule.
Student will depart from school via WSBVI Charter Bus/Plane Transportation the week prior to absence.
Student will be picked up from school by a Parent/Guardian.
Student will be picked up from school by an Approved Visitor:
If student will be dropped off at school: What day & time?
Return method of transportation
Please note that WSBVI Charter Bus/Plane Transportation is only available on designated transportation days. Please call Andy Soto at 608-758-6159 if you have questions regarding the Charter Bus/Plane Transportation schedule.
Student will ride WSBVI Charter Bus/Plane Transportation back to school the week after absence.
Parent/Guardian will drop student off at school
Anything else you'd like us to know?
Is there anything else you would like for us to know? This is your space to share any and all details surrounding this absence.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Wisconsin Center for the Blind and Visually Impaired.