Absence Excuse Form

1.	Student Name:*

2.	Homeroom Teacher:*

3.	Date of Absence:*
	mm/dd/yyyy

4.	Reason for Absence:*
	--Please Select--IllnessDeath in Immediate FamilyAppointmentCourt or Administrative ProceedingsReligious Observance

5.	Grade Level:*
	--Please Select--678

6.	Parent / Guardian's Name:*

7.	Phone Number:*

8.	E-mail Address:

9.	Additional Comments: