Jerabek Absence Reporting
Please complete this form to report your student(s) as absent. This form may be completed multiple times to report multiple absences if needed.
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Student First Name *
Student Last Name *
Teacher / Room Number *
Date of absence *
MM
/
DD
/
YYYY
Date Returning to School
MM
/
DD
/
YYYY
Reason for absence
Examples: Illness (must specify symptoms, fever, cough, stomach ache, etc.), out of town, medical appointment, family emergency, etc.
 *
Name of Person Reporting *
Relationship to student *
Telephone Number *
Submit
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