MNVA Elementary and Middle School Absence Report
Please note this form must be completed by the student’s parent or legal guardian, except in the instance of a student age 18 or over who is acting as his or her own learning coach. MNVA reserves the right to confirm all absences directly with the person whose name is represented below. Falsely reporting absences may be considered an act of academic fraud, which is subject to disciplinary action under the guidelines found in the MNVA Student Handbook.

***If your student will be gone for more than a couple of days, please be sure to also notify his/her teacher(s) to discuss a plan for assignment completion.

***The intent of this form is to report an absence for today or a future absence to the MNVA. Absences from the past cannot be reported here and will not be altered based on this form being filled out. If you would like to discuss past absences, please contact your student's teachers.

Student First Name: *
Your answer
Student Last Name: *
Your answer
Student Grade Level: *
Date of Absence (one date per form): *
MM
/
DD
/
YYYY
Reason for Absence: *
Your answer
During which class(es) will your student be absent? *
Your answer
Parent/Guardian Verification
By typing your name in the space provided below, you are confirming that you are a legal guardian of the student whose absence you are reporting, or you are a student age 18 or over and legally entitled to represent yourself. Completion of this form does not guarantee an absence will be considered excused. Absences may be excused because of illness, religious observance or instruction, family emergency, funeral and bereavement, or for medical, dental, orthodontic or counseling appointments. All other absences are presumed to be unexcused (Minn. Stat. 120A.22, Subd.12).
Name of parent/guardian completing this form: *
Your answer
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