Pre-Excuse Form

Essex Community Schools
111 Forbes Street
Essex, Iowa 51638
Phone: 712.379.3115

PRE-EXCUSED ABSENCE
STUDENT'S NAME
DATE ISSUED		/ /
DATE STUDENT WILL BE ABSENT THROUGH THESE FOLLOWING DATES		/ /
DATE STUDENT WILL BE ABSENT THROUGH THESE FOLLOWING DATES		/ /
REASON FOR STUDENT'S ABSENCE
ASSIGNMENTS TO BE COMPLETED: TEACHER'S SIGNATURE INDICATING COMPLETION AND APPROVAL
Subject	Assignment	Approval Signature
1.	___________________________	______________________
2.	___________________________	______________________
3.	___________________________	______________________
4.	___________________________	______________________
5.	___________________________	______________________
6.	___________________________	______________________
7.	___________________________	______________________
8.	___________________________	______________________

Parent's Signature: _______________________________________________ Date:_______
The above form must be printed, completed, and returned to the office before the planned absence or permission for this student to attend the above function will be denied.

PRE-EXCUSED ABSENCE