Absent Student Form
Please fill out a separate form for each student who will be absent.
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Student Name *
Grade *
Parent's Cell Phone Number *
Parent's Email Address *
Date(s) Absent *
MM
/
DD
/
YYYY
Reason for Absence *
Critical Symptom For Which Your Student MUST Stay Home: (The USCO Health Coordinator will be in contact with you.) If child is sick, list symptoms:
Date Symptoms Started (if it applies) *
MM
/
DD
/
YYYY
Planned Days Absent *
Date of return to school if known
MM
/
DD
/
YYYY
Is there anything else we need to know regarding this absence? Any symptoms not listed? Student driving him or herself?
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