Absence Excuse Form
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1Absence Excuse Form — Request for Consideration
(Please use one form for each missed assignment)
Last name: __________________________ First name: ____________________________
E-mail address: ______________________________________________________________
Student ID number: ______________________________ Phone: ____________________
Course number: ________ Section number: _____________ Semester/Year: ___________
Instructor: ______________________________________
Assignment Missed (circle one):
Laboratory
Recitation
Workshop
Quiz
Exam
Other ___________________
Date: ________ Assignment: ___________________________________________________
Reason (check one) and attach documentation:
_
Personal Illness/Injury
Death of Family Member
_
Other _________________
_
Explanation: _______________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Student Signature: _______________________________________ Date: _____________
Departmental Use Only
_
Approved
Not Approved
_
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