Student Absentee Request
Student name
First Name
Last Name
Student grade
Please Select
K5
1st & 2nd
3rd & 4th
5th
6th
7th & 8th
9th & 10th
11th & 12th
Parent E-mail Address (to receive notification when the process is completed)
example@example.com
Upcoming Absence Dates
Starting Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ending Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for absence (please be specific):
Responsibility Acknowledgment
By signing this form, I understand that, whether or not this absence is excused or unexcused, missed work is required. I am also aware the GCA policy for late work states that, for an excused absence, work is due 7 days from the date of the student’s return to school, and, for an unexcused absence, work is due 7 days from the date the assignment was due. A reminder to this effect will be sent as soon as the request is processed.
Acknowledgment of Responsibility
By signing this form, I understand that, whether or not this absence is excused or unexcused, missed work is required.
Parent Signature
Submit
Should be Empty: