Band Absence Request Form

Band Absence Request Form
Note: Requests for excused performance absences must be made directly to Dr. Lortz. If approved, you will then complete this form. Please review the Attendance Policy in the course syllabus for details on excused and unexcused absences.

Procedure:
- Submit this form within one week of the anticipated absence.
- For illness, email a doctor’s note with the date and time to Dr. Lortz (mlortz@stevenson.edu).
- For major illnesses or injuries, email medical documentation outlining restrictions, return dates, and accommodations to Dr. Lortz (mlortz@stevenson.edu).
Full Name*

First NameLast Name
Email Address*
example@example.com
Your Section*
Please ensure all information is accurate and complete before submitting your request. Thank you for your cooperation!
Date of Absence*

MonthDayYear
Date
Reason for Absence, Tardy or Leaving Early*
Should be Empty: