Galloway Absent Request Form

STUDENT'S LEGAL FIRST AND LAST NAMErequired

First Name

Last Name

PARENT/GUARDIAN'S EMAIL ADDRESSrequired

PARENT/GUARDIAN'S FIRST AND LAST NAMErequired

First Name

Last Name

Grade Level required

NAME OF STUDENT'S TEACHERrequired

DATE ABSENT ( FIRST DAY ): IF MORE THAN 3 DAYS HAVE PASSED, THE ABSENCE CANNOT BE EXCUSEDrequired

Must contain a date in M/D/YYYY format

DATE ABSENT ( LAST DAY ): IF MORE THAN 3 DAYS HAVE PASSED, THE ABSENCE CANNOT BE EXCUSED.required

Must contain a date in M/D/YYYY format

REASON FOR ABSENCErequiredPlease select up to 1 choice

SEEN BY A DOCTOR ( WAS THE STUDENT SEEN BY A MEDICAL PROFESSIONAL? )

MEDICAL ( NO DOCTOR )

CIRCUMSTANCE ( NON MEDICAL LIMITED TO 10 PER SCHOOL YEAR )

ONLY PARTIAL DAY ABSENCE

Please select up to 1 choice

PLEASE NOTE

IF THE STUDENT WAS SEEN BY A DOCTOR, PLEASE HAVE THE STUDENT BRING THE DOCTOR'S NOTE TO THE ATTENDANCE CLERK LOCATED IN THE MAIN OFFICE. IN ORDER FOR THEM TO BE AN EXCUSED ABSENCE.

ONCE YOU SUBMIT

YOU WILL RECEIVE A CONFIRMATION EMAIL

THANK YOU

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Galloway Absent Request Form

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Galloway Absent Request Form

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