High School for Math Science and Engineering Student Excuse Absence Form
If You Have A Doctor’s
Note Attach It
Here or on back
Student Name: _________________________________
Student OSIS #: ______________________________
Date(s) of Absence: _____________________________
__________________________________________
Explanation of Absence:
If your child is absent or late for any of the reasons
below, place a check next to the respective box. If
there is another explanation, please indicate briefly.
Then, instruct your child to take the note to Room
B-10 ONLY AFTER the note has been signed by all of
your child’s teachers.
o
Religious Observance
o
Illness (Written confirmation)
o
Late (Written Confirmation) Attd. Rev
Students: Please ask each of your subject teachers to sign the line of the
respective class period. Please keep note for personal records.
1
_______________________________________
2
_______________________________________
3
_______________________________________
4
_______________________________________
5
_______________________________________
6
_______________________________________
7
_______________________________________
8
_______________________________________
Parent’s Signature:
Date:
9
_______________________________________
Telephone #:
10 _______________________________________