Student Name
*
First Name
Last Name
Students Grade Level
*
Please select a grade...
Pre-K / K
1
2
3
4
5
6
7
8
9
10
11
12+
Student ID (leave blank if unknown)
This is NOT a required field.
Name of Parent/Guardian Submitting Form
*
First Name
Last Name
Parent/Guardian Contact Number
*
-
Area Code
Phone Number
Parent Email
example@example.com
Start Date of Absence
*
-
Month
-
Day
Year
Date Picker Icon
End Date of Absence
-
Month
-
Day
Year
Date Picker Icon
Reason for Absence
*
Illness
Medical Appointment
Bereavement / Funeral
Religious Reason / Service
Driver’s Test (unexcused)
College Visit (must submit additional form from office)
Military Service
Other (Please explain below)
Additional Information (optional)
You may enter details about the absence.
Attach A File (optional)
Browse Files
You may attach a scan or cell phone photo of the child's doctor excuse.
Cancel
of
Submit to School
Should be Empty: