Student Absence Form

NOTE: This form is not required and is strictly optional. It is provided only as a means of assisting faculty and students in keeping records of agreements made if a student needs to miss scheduled classes.

Students: Please fill out the form and meet with your instructor.

This form must be accompanied by a letter from the UNL faculty or staff member requiring the absence, documenting the reasons for the missed classes.

Name:______________________Course:_________________ Instructor:__________________

Name of instructor/staff member requiring absence(s):__________________________________

1. Because I have an obligation to participate in/attend the following required activities, I would like permission to miss the following classes:

Date	Activity	Coursework	Initials

2. I may be required to participate in the activities listed below. As soon as I am aware that my participation is required I will notify the instructor, otherwise I will attend class.

Date	Activity	Coursework	Initials

I (do/do not) grant permission for the student named above to miss the classes indicated above. Special accommodations, if necessary, and/or consequences are specified below.

_______________________________ (Instructor Signature)

I understand these conditions _____________________________________(Student Signature)

Date __________________