Attendance Excusal Request '24 -'25

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You may use this form to request to excuse a student's absence at Jefferson Elementary School in Davenport, Iowa.

Email *

Full name of person completing this form. *

Full name of student. *

Please complete a separate form response for each student.

Birthdate of student. *

YYYY

Reason for absence (check all that apply.) *

We collect symptoms both to justify the excusal, and to report trends in symptoms to Scott County Public Health. We do not share individualized information with the health department.

Students should be free of fever, vomiting, or diarrhea symptoms (without fever-reducing medication) for 24 hours before returning to school.

Medical, dental, or vision appointment (pre-scheduled)

Fever

Vomiting

Diarrhea

Rash

Headache

Eyes (redness, swelling, itching, etc.)

Other:

Required

Will the absence be a full day or partial day? *

Full Day

Partial Day

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