Report an Absence, Reportar una ausencia 
Please fill out this form as completely as possible. If you have any questions, you can call the front office at (916) 294-9110 or email the attendance clerk at kanwhite@fcusd.org.
Favor de llenar la forma lo mas completa posible. Si tiene alguna pregunta, puede llamar a la oficina
(916) 294-9110 o enviar un correo electronico a la secretaria al kanwhite@fcusd.org
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Email *
Phone # *
Numero de telefono *
Student's name *
Nombre del estudiante *
 *
Student's Teacher *
Nombre del maestro *
 *
Date of absence *
Dia de ausencia *
 *
MM
/
DD
/
YYYY
Reason for absence *
Razon de la ausencia *
Column 1
Illness- (please list symptoms below) Enfermedad-(ponga la lista de sintomas abajo)
Doctor/Dentist Appointment Cita de Doctor/Dentista
Other (please explain in additional notes)Otro (explique en las notas adicionales)
Clear selection
Symptoms *
Sintomas
Other/ Additional Note *
Otros/ Nota Adicional *
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