EmailMe Form - Academic Year Student Absence Form

Student Name *

First Last

High School

Grade Level *

Date of Requested Abscence *

MM / DD / YYYY

Is this an ongoing activity? *

Yes

No

IF yes, please provide an estimated end date

MM / DD / YYYY

Reason for Absence (Please check all that apply) *

Sports Activity (must submit schedule to CUB office)

School Club/Organization Activity

Recreational Club/Organization Activity

Other

Parent Name

First Last

Parent e-mail

Parent Phone

### - ### - ####

Preferred Contact Method *

Please tell us how you prefer to be contacted should we have questions.