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Student Absence Excuse
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Important: A parent/guardian must submit a valid excuse note within five days of a student's return to school for the absence to be deemed excused.
Name of Scholar
*
Your answer
Return to School Date
*
MM
/
DD
/
YYYY
Grade Level
*
Your answer
Campus
*
Choose
Elementary
Middle
My scholar was (check one) absent or tardy on the dates below.
*
Choose
absent
tardy
List consecutive absent/tardy dates. (Example format 8/31/2020). A separate form must be used for non-consecutive attendance dates.
date 1
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MM
/
DD
/
YYYY
date 2 (if applicable)
MM
/
DD
/
YYYY
date 3 (if applicable)
MM
/
DD
/
YYYY
date 4 (if applicable)
MM
/
DD
/
YYYY
date 5 (if applicable)
MM
/
DD
/
YYYY
List all additional dates:
Your answer
Select the reason your scholar was absent/tardy from school and provide additional documentation (*) if required below.
*
Choose
Student Illness (*Doctor’s note if absent three (3) days or more)
Quarantine (*Doctor’s note)
Medical or dental appointments (*Doctor’s Note)
Failure of DC government to provide transportation
Judiciary proceedings (*Court documentation/note)
Death in the family *(Obituary or other sufficient documentation)
Observance of religious holidays
Temporary closing of the school facility
Allowances for the student to visit a parent before or after military deployment
Other extenuating circumstances left to the discretion of the principal or school administrator
Explain extenuating circumstance reason here:
*
Your answer
What is your phone number? (numbers only, no dashes)
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Your answer
What is your email?
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Your answer
What is your name? (first/last)
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Your answer
Check here to confirm you are the child's parent or guardian:
*
I am this scholar's parent or guardian listed above.
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