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HMK Student Required Absence Note 4-6
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* Indicates required question
Name of Student
*
Your answer
Date of Absence
*
MM
/
DD
/
YYYY
Teacher
*
Your answer
Grade
*
4th
5th
6th
Valid Excuse
*
Illness/Medical Appointment
Family Death
IEP or 504 Plan
Other:
Parent/Guardian name
*
Your answer
Parent/Guardian phone number
*
Your answer
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