Absence Notification Form

*First Name:

*Last Name:

*Id Number:

*Phone Number:

*Email:

*Date of Absence(s) (Format: mm/dd/yyyy):

*Courses Missed (Course Name(s) & Faculty Name(s)

*Reason for the Absence:
Medical Issue/Emergency
Death in Immediate Family
Personal Emergency/Crises
Military Orders/Reasons

I understand a notification of absence does not excuse me from assignments, exams or other expectations of the course I have missed. I also understand that I have to follow-up with my faculty member(s) to discuss next steps for successful completion of the course.

I understand to complete this request I must submit relevant documentation to Academic Services either by email (to academicservices@lewisu.edu) or in-person by dropping documentation off to Academic Services in the Learning Resource Center, Suite 342

*Security Password (Please type the word

):
* Required