To: Julius West Middle School Attendance Secretary
From: ______________________________________
(Parent Name)
Date:_________________
Contact Phones: _______________ Work
_______________ Home
_______________ Cell
Student Name:_______________________________
Student ID Number:___________________________
Check one:
 Will be picked up by:_____________________
At________________am/pm
Because________________________________
 Was late/absent because:_________________
_______________________________________
 Other:_________________________________
_______________________________________