PS140O Absence Reporting Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form if you wish to request an excused absence from the class. Your request and reason for the absence will be recorded and taken into account as we calculate your participation grade. Please note that you are responsible for completing all work by the assigned date unless you have previously secured an extension from Professor Wasow.

Email *

Last Name *

First Name

Cal email address

Reason for Absence.

Personal Medical Reason

Family Medical/Care Reason

Extracurricular Activity: Sports Team Away

Extracurricular Activity: Student Organization Away from Campus

Vacation/Family Event (Unexcused Absence)

Other:

Clear selection

You may offer a brief explanation of your absence here. Please note: you do NOT need to share private medical information or details of your medical conditions, and providing more medical details will not affect whether your absence is excused. Scheduled work shifts (which should not conflict with this class) and on-campus and off-campus organizational activities and obligations are not excused absences.

Date of Absence 1

YYYY

Date of Absence 2

YYYY

Date of Absence 3

YYYY

Please offer any more details that you think would be useful to Professor Wasow or your GSI.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms