Request for an Excused Absence or Excused Late

1. Your Name: _____________________

2. Course Title: ____________________

3. Scheduled Days and Hour of the Course: ________________

4. Today’s Date: _______________________

(Must be submitted no later than 1 week after the absence or late.)

5. Excused Absence for the Date of ___________ or Excused Late for the Date of __________

Reason:

Type of Documentation (attach):

______________________________________________________________________________

This section will be returned to you if your request is not approved.

Excused absence or late for the date of _______________ was not approved.

Reason: