Office of Student Affairs Excuse Request
EXCUSE REQUEST: No excuse will be honored if it is more than ten (10) class days old. No documentation will be honored if it appears altered. Each submission will be date and time stamped. Email supporting documentation to studentservices@myasu.alasu.edu.
Date of Birth *
MM
/
DD
/
YYYY
Last Name *
Your answer
First Name *
Your answer
Student ID# *
Your answer
Classification *
Your answer
Telephone or Cell Number *
Your answer
Email Address ("myasu" email address only) *
Your answer
Date(s) Absent *
Your answer
Reason 1. Verified Illness (Medical Reason - On Campus - Health Center) *
Health Center (Required)
Your answer
Reason 1a. Verified Illness (Medical Reason - Off Campus) *
Please provide the name of the Hospital, Physician and Telephone Number (Required)
Your answer
Reason 1b. Verified Illness (Medical Reason - Doctor's Appointment) *
Please provide the name of the Physician and Telephone Number
Your answer
Reason 2. Death in the Immediate Family *
Please provide the Relationship to the Deceased and Funeral Home Information (Required)
Your answer
Reason 3. University Authorized Business *
Please provide the Area or Department
Your answer
Reason 4: Other *
Required
Instructor(s) Name, Course and Time *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Alabama State University.