Ateneo de Zamboanga University

SENIOR HIGH SCHOOL

Office of the Prefect of Discipline
La Purisima Street, Zamboanga City 7000 | 991 – 0871 local 3034

EXCUSE FORM
GENERAL INSTRUCTION:
1. PRINT TWO (2) COPIES of the form.
2. Accomplish the form.
3. Proceed to the Office of the Prefect of Discipline (OPD).

NAME: ________________________________________________________ GRADE LEVEL: 11 12

STRAND: ABM HUMSS STEM SECTION: __________________________________

START DATE OF ABSENCE: __________________________________

END DATE OF ABSENCE: ____________________________________

REASON OF ABSENCE:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Attachments and Other Supporting Documents: _________________________________________________

__________________________________________ __________________________________
Parent/Guardian’s Signature over Printed Name Student’s Signature

__________________________________________
Parent/Guardian’s Contact Number

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To be filled by the OPD Personnel

Date Filed: ____________________________________ Time: _______________

Remarks:
This excuse is VALID

This excuse is NOT VALID

__________________________________________
OPD Personnel
CC: AdZU SHS OPD