2021-2022 Pitts School Road Elementary School Absence Form
Good attendance is critical for student success at PSRES. All absences will be coded unexcused unless this completed form, an email, a doctor/dentist note, or a written note from the parent/guardian is received. State law allows absences to be excused for the following reasons: Illness or injury, Quarantine, Death in the immediate family, Medical or dental appointments, Court or administrative proceedings, Religious observance. All other absences are coded as unlawful. Absences for personal trips or family emergencies are not excused according to state guidelines. In order to be considered in attendance, a student must be present at least one-half of the school day. At the elementary level more than ten (10) absences a semester or 20 absences a year are considered excessive. If illness is given as the primary reason for non-attendance, the principal (at his discretion) may request a physician’s documentation.


*NOTE: This form is to be used for FULL DAY ABSENCES ONLY. Late arrivals and early dismissals may only be excused if a doctor or dentist note is submitted.

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Student Last Name *
Student First Name *
Grade *
Homeroom Teacher *
Date of ABSENCE (First Day if Multiple) DO NOT USE FOR EARLY DISMISSALS OR LATE ARRIVALS. *
MM
/
DD
/
YYYY
Last Date of Absence (If Applicable)
MM
/
DD
/
YYYY
Reason for Absence *
Parent/Guardian Name *
Phone Number *
Email Address *
Is this absence related to COVID-19? [If YES, only submit this form ONCE - not for each absent day] *
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