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Student Excused Absence Form

Student Name*

(Last, First, MI)

Answer Required

Parent Name*

(Last, First, MI)

Answer Required

Reason for Absence*

(Check all that apply)

Answer Required

Illness

Doctor or Dentist Appointment

Death in the Family

Other:

Please upload the applicable note below. If neither a doctor's note or a parent's note is uploaded, your child's absence will not be excused.

Doctor's Note

Answer Required

Choose a file or drag it here.

Parent's Note

Must include a parent signature.

Answer Required

Choose a file or drag it here.

Date to be Excused *

(If multiple dates, please insert the date of the first absence)

Answer Required

If multiple dates, please enter start and end dates below.

Answer Required

I certify that I am a Parent/Legal Guardian of the student named above and certify the above to be truthful.*

Answer Required

Yes