Participant Absence Request Form

**This form can be submitted to inform about absence to program activities throughout the year due to any one of the reasons:
1. Required School Activity
2. Illness
NOTE: Other absences due to personal reasons are not excused - Please contact program.
****Must be submitted before or within one week of absence to be excused.

Participant Name
Date Submitted Date Submitted / MM / DD YYYY
1. School / Organization sponsoring activity
Activity to be participated by the student
Date of Participation Date of Participation / MM / DD YYYY
From From : HH MM AM/PM
To To : HH MM AM/PM
School / Organization Contact School / Organization Contact - ### - ### ####
Upload note (if needed)

Attach Files
OR
2. The above student could not attend activity due to illness on 2. The above student could not attend activity due to illness on / MM / DD YYYY
Upload note (if needed)

Attach Files
Any Comments:
Participant Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent / Gauardian Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
SCHOOL RELATED ACTIVITIES or OTHER ACADEMIC ACTIVITIES: Students who miss a sponsored Upward Bound Math and Science Activity (ies) due to participation in a School related and/or academic events if possible, may provide proper documentation verifying participation. Students will be held responsible and should contact the program for any missed information/assignments given on the date(s) of absence. The form must be completed entirely to be considered proper documentation.

Participant Absence Request Form

OR