2. Instructions
   Complete all required fields. Only parent/legal guardian can authorize an absence or tardy. IP addresses are linked to this form to verify the validity of the absence and/or tardy.
4. Student First Name*
5. Last Name*
7. Student Grade*
   -- Select One --678
9. Parent First Name*
10. Last Name*
12. Parent Email*
13. Parent Phone Number*
15. Date of Absence*
    Date of Absence
16. Student Was (Choose ONE)*

    1. Tardy to School
    2. Absent to School
18. Reason for Absence or Tardy*
    -- Select One --Illness of StudentIllness of Family MemberDeath of the FamilyReligious Holiday of the Student's Own FaithRequired Court AppearanceSpecial School or Educational Event (Please Explain)Scheduled Medical Appointment (you must submit the medical form from the doctor)Other (please explain)

    Only one selection can be made.
20. Comment
22. Medical/Hospital Note Upload
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field