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Student Info
Student Name
Teacher Name
Grade
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Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Absence/Late Info
Will the student be absent or late?
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Absent AM
Absent PM
Absent all day
Late
Absence Date
Absence Date: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Absence Date: Day
Day
1
2
3
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5
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31
Absence length
Yes this is a multi-day absence
Last Day of Absence
Last Day of Absence: Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Last Day of Absence: Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Reason for Absence
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Medical/Dental Appointment
Sick/Illness
Stress/Anxiety
Bereavement
Vacation
Weather
Other
Other Reason for Absence
Sick Symptoms
Parent Info
Parent Name
Parent Email
Parent Phone
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