Student Absentee Request

Student Absentee Request
Student grade
Student name
Student name
Student name
Student name
Student name
Student name
Student name
Student name
Student name
Student name

First NameLast Name
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