Student Absentee Form

Student's First Name

Student's Last Name

Class

Date of Absence - From

Date of Absence - To

Reason for Absence *

Notified Absence - Sick (Certified) ** Certificate required for more than 3 days **

Notified Absences - Sick (Uncertified) ** Certificate required for more than 3 days **

Notified Absence - Appointment (Detail Times Below)

Notified Absence - Other (Additional Information Required)

Late or Early Departure - (Detail Times Below)

Planned Absence Request - More than 3 days (Principal approval required, complete additional information)

Upload Medical Certificate Upload File

Additional Reason for Absence

Parent/Guardian Name

Contact Phone Number

Contact Email