Excused Absence Request Form
*All submissions of this form will be emailed directly to the Office of Student Affairs
Name:
*
First Name
Last Name
I am a
*
Fairfax student
Winchester student
E-mail
*
I am a
*
P1
P2
P3
Dates/times requested as excused absence(s):
*
Please select the reason for your excused absence request:
*
Medical
Other
Names and course numbers of the classes that will be missed:
*
Names of the course coordinators for the classes that will be missed:
*
Please upload any documentation for your absence (e.g. doctor's note, court summons, etc.). Student Affairs may require documentation before your absence can be excused.
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