Request For Excused Absence
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1Request for Excused Absence
Name ________________________________________ I.D.# _________ Day/Date of Absence ____________
Reason for Absence ____________________________________________ Absences to Date ________________
Period
Class
Teacher – Approximate Grade
Approve
Approve with
Do Not
Teacher Signature
Reservation
Approve
1
2
3
4
5
6
7
THIS FORM MUST BE COMPLETED AND RETURNED TO THE DEAN OF STUDENT’S OFFICE AT LEAST TWO SCHOOL
DAYS PRIOR TO THE STUDENT’S ABSENCE. FAILURE TO DO SO WILL RESULT IN DISCIPLINARY ACTION.
FAILURE TO SUBMIT A COMPLETED FORM PRIOR TO THE STUDENT’S ABSENCE WILL RESULT IN AN UNEXCUSED
ABSENCE FOR EACH CLASS PERIOD MISSED.
Please reference the Parent/Student Handbook for specific information about Brophy’s absence policy.
I have read this completed form, understand the consequences herein and request an excused absence for my son
on the above date(s).
Parent Signature _____________________________________________
Date
_______________
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