STUDENT ABSENCE FORM

 

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 __________________