Please use this form to report student absence:
Name of Student:
Name of Teacher:
First Date Absent:
Last Date Absent:
Total Number of Days Absent:
What is the reason for the absence?
We are currently reporting to the Health Department illnesses with influenza-like symptoms.  (The child's name will be kept confidential).  If you are reporting an absence due to illness, please indicate all applicable symptoms the child is experiencing:
Fever:     Sore Throat:      Cough:
Runny Nose:     General Unwell Feeling:
The Student will be:
Clarification: (no clarification is required if student will be absent all day)
Name of Person Reporting Absence:
Email Address of Person Reporting Absence:
   
Security Code:
Type the code shown:
  Â