Dear Instructor:

I will be off campus from 10:30am until 2:30 pm on Thursday, January 18th in a
required activity of ID Trip which is taught by Rund Hiyasat Katarzyna Tracz, and
Maruan Halabi. I request your permission not to count my absence from your class
during this time.

Student’s name: _________________________

Student ID #: ____________________________

1. Course affected: _________________ Accept as ‘no absence’ ____ Yes ___ No

Instructor’s signature _______________________ Date ___________________

2. Course affected: _______________ Accept as ‘no absence’ ____ Yes ____ No

Instructor’s signature _______________________ Date ___________________

3. Course affected: _______________ Accept as ‘no absence’ ____ Yes ____ No

Instructor’s signature _______________________ Date ___________________

4. Course affected: _______________ Accept as ‘no absence’ ____ Yes ____ No

Instructor’s signature _______________________ Date ____________________

INSTRUCTORS: You may approve the student’s absence from your class for the
purpose of class-related work with no absence OR you may not approve the absence,
in which case the student will be marked as absent from your class. The student is still
to be held accountable for all work (written assignment, quiz, test) missed by not
attending your class. You are not required to give a makeup assignment or
examination.

SPONSOR: Give a copy of this form to every student who participates in the activity.
Collect the completed forms from the students and forward a complete list of students
who receive permission to leave campus to Enrollment Services, with copies to your
assistant dean or supervisor and the campus director (for use at the security gate).

cc. Assistant Dean, Chair or Supervisor

Campus Director or Director, Campus Physical Development

Forms ACA-ADM-10-1