Student Absentee Request

Student Absentee Request
Student name
Student name

First NameLast Name
Student grade
Parent E-mail Address (to receive notification when the process is completed)
example@example.com
Upcoming Absence Dates
Starting Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Ending Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for absence
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
Parent Signature
Should be Empty:

Upcoming Absence Dates