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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 __________




















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.