Absence Request Form

Student Name *

Date of Absence Request *

MM

/

DD

/

YYYY

Type of Absence *

Illness

Doctor's Appointment

Funeral

Religious Holiday

COVID Quarantine

Other:

Explanation of Absence *

Telephone Number *

Doctor's appointments and illness longer than three days require a doctor's note to be submitted to the secretary upon return in order to be marked excused. *

I understand and will provide a note when I return.

The absence is not a doctor's appointment or illness longer than three days.