Comp 101/102: Class Absence Form
Directions Complete this side of the form
Student Name:

.
Date(s) of Absence(s): .
On an authorized trip (need official notice) Yes / No (Circle One) -- Organization Involved:
Involved in an emergency beyond my control Yes / No (Circle One)

If yes, give reason

 

Explanation:

 
Too sick to attend class Yes / No (Circle One) -- If yes, complete the following verification.
Name of Verifier .
Position of Verifier .
Phone number of Verifier .

Authorization

 

 

I verify that the statement(s) made by the student who signed the note below is (are) both accurate and true.

(Signature) ____________________________________

(date)___________________

Additional Notes/Comments

 

.

 

 
Student Signature

.