3+ Day Absence Excusal Request
Extended Absences are 3 or more days. The submission of this form does not guarantee approval. The request must be reviewed and can take up to 3 school days, if all requirements are met.
Student's Name
*
First Name
Last Name
Grade Level
Please Select
KK
1st
2nd
3rd
4th
5th
6th
7th
8th
Select the Grade
Will more than 1 scholar be absent?
Yes, 2+, or more, scholars
No
Requesting Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Absence Begins
*
-
Month
-
Day
Year
First Day of Absence
Scholar Returns
*
-
Month
-
Day
Year
Date of Return to School
Reason for Absence
*
Please Select
Death in the Family
Family Emergency
Medical Concern
Religious Observation
Other
If "Other" please provide a description below
Please give a detailed reason for your request
*
List other DIA students that will also be absent
Include the names, and grade levels, of the others.
Supporting Document Submission
Browse Files
Drag and drop files here
Choose a file
If you have any issues uploading here, try emailing it to diattendance@duboisintegrityacademy.com. Documentation must be submitted within three days of the scholar's return to school. Without supporting documentation the request is less likely to be reviewed.
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