Teresa
Massoels
Excused Absence Form
This form is to request an excused absence. Completion of this form
does not guarantee the
excuse will be granted. A copy of this form must be completed for each
absence which occurs.
Anyone with absences risks failing the course. The request for an
excused absence must occur
24 hours prior to the excused absence.
In the event of an illness, the request must be made
within one week of the absence. It is the student's responsibility to
copy this form for
submission to the instructor. Please feel free to make as many copies
as you feel necessary.
The instructor will not supply additional copies.
Name: _______________________________________
Course Time: __________________________________
Date of Absence: _______________________________
Reason for Absence: _________________________________________________
_________________________________________________________________
_________________________________________________________________
Student's Signature ______________________________________
Date: ________________________________________________
By signing this document, I am assuring that the reasons given above
for the absence are a
true and correct account of the situation. I fully understand if I have
misrepresented the fact
in a way, it may result in my failure in the course and I may be turned
into the Dean for
Academic Dishonesty.
Faculty
Decision
The above absence was excused ________
Faculty Signature _________________________________________________
The above absence was not excused for the following reasons:
Faculty Signature _________________________________________________