STUDENT ABSENCE FORM

Student Name: ____________________________________

LRN: ___________________________
Grade and Section: ________________
Parent’s Name: ____________________________ Phone #: ____________________

The above named Student was absent from school on the following day/days:

The student returned to school on:

________________________________________________________
The student attached a note (please check what is applicable)
 Parent’s note or Parent’s Signature ____________________________________
 Doctor’s note
 Other (please specify) _______________________________________________

PLEASE HAVE THIS FORM SIGNED BY ALL TEACHERS. BRING THIS COMPLETED FORM
WITH THE ATTACHED NOTE TO THE ADVISER.
PERIOD SUBJECT TEACHER’S SIGNATURE
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*Note: Students are required to make up any missing class work, homework, or tests.

Signed:

LAURICE CORRINE G. ROSA

9 Cypress Adviser

Attested:

MERCY P. MAAYA, MTII

Curriculum Head