Reporting an absence/ Reportando una ausencia

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Parent or Guardian must fill out the form/ Un padre o guardian debe completar el formulario. Llene una forma para cada estudiante.

Student Name/ Nombre de estudiante: *

Grade and Teacher/ Grado y Maestra *

3rd Grade: Ms. Hsu, Ms. Hoff, or Mr. Nguyen

4th Grade: Mr. Carranza, Ms. Defouw, or Ms. Pinto

5th Grade: Ms. Robinson, Ms. Snyder, or Ms. Tickel

6th Grade: Mr. Zape, Mr. Haynes, or Ms. Minor

7th Grade: Mr. Flint, Ms. Martin, or Ms. Vance

8th Grade: Ms. Baltay, Ms. Mannansala, or Ms Suresh

Telephone of person filling out form/ Teléfono de persona completando la forma *

Relation of person to absent student/Relación al estudiante ausente: *

Mother/Mama

Father/Papa

Grandparent/Abuelo/a

Step-parent/Padrastro/a

Other:

Reason for Absence/Razón por Ausencia *

Fever/ Fiebre

Cough/ Tos

Stomach Ache/ Dolor de estomago

Headache/ Dolor de cabeza

Throwing up/ Vomito

Covid Positive result/ Resultados positivos de Covid

Exposed to a Covid positive case/ Expuesto a alguien positivo de Covid

Doctor/Dentist Appointment/Cita con Doctor/Dentista

Other:

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