Hawken School Absence Form

Hawken School Absence Form
Name of Student*

Student First NameStudent Last Name
Division & Campus Location*

Early Childhood - LyndhurstLower School - LyndhurstMiddle School - LyndhurstBirchwood School - ClevelandUpper School - Gates MillsMastery School - University Circle
Grade*
Grade*
Grade*
Grade*
Grade*
Teacher/Advisor
Time of Absence*

Will be out one dayWill be out more than one dayComing in lateLeaving mid-day and returningLeaving early
Date of absence*

MonthDayYear
Date
First date of absence*

MonthDayYear
Date
Last date of absence*

MonthDayYear
Date
Estimated Time Out*

Hour Minutes

AM/PM Option
Estimated Time In*

Hour Minutes

AM/PM Option
Reason for absence*

IllnessAppointmentTravelFamily Death/FuneralObservance of a HolidayCollege VisitOther
Reason for absence*

IllnessAppointmentTravelFamily Death/FuneralObservance of a HolidayCollege VisitMental Health DayOther
Thank you for taking a step to create balance, rest, and rejuvenate! Hawken Upper School offers two Mental Health Days during the school year, and it is one step that can be taken to care for a student’s mental health needs.

When taking a Mental Health Day, students are encouraged to engage in activities that will contribute to long-term resilience, which may include stepping away from social media and trying out the following:
- Engaging in an activity that brings joy, such as a favorite hobby.
- Physical activity such as taking a walk, yoga, or other other enjoyable exercise.
- Traveling outdoors and taking in the environment.
Note: If a student needs more than two mental health days, the student and family can meet with a Dean and school psychologist to assess what can be done to reduce stress and what other supports/accommodations we can provide to support the student's well-being and learning.
Reason for mental health day:*

Need an opportunity to rest and recharge, and/or manage stressExperiencing symptoms of depression (Note: If your child is experiencing symptoms of depression, they should not be left alone during the Mental Health Day)Other (requires explanation)
Mental Health Day Explanation*
Would you like the admin team or school psychologist to follow up with your child?*

NoYes
If this is an emergency, call 911.

If this is not an emergency, someone will be in contact within 72 hours. Follow-up by an advisor, administrator, and/or school psychologist may occur the day of and/or after the Mental Health Day.

Reason for absence - additional information*
Symptoms*

Fever 100.0 or higherHeadacheNausea/vomitingBody achesExtreme fatigueChillsNew onset or worsening nasal congestion not associated with allergiesDiarrheaLoss of smell or tasteSore throatNew onset coughChest pain or difficulty breathingRashEye drainageTested positive for strep throatTested positive for fluTested positive for COVID-19Other symptom or information, please explain
Explain additional symptoms or provide information
Is your child an in-season athlete?

YesNoN/A
What sports?
Contact name*

Parent/Guardian First NameParent/Guardian Last Name
Contact email*
example@example.com
Contact phone number*
Please verify that you are human*
Should be Empty: