NOTICE OF ABSENCE
This completed form is due at least one week prior to the Upward Bound activity or event that will be missed.
Participant Name (please print): ______________________________, _____________________________
(Last) (First)
Check one: Single activity absence request Multiple activity absence request
Date(s) of absence: _______________, _______________, _______________, ______________
Reason for absence (check and please provide sufficient detail and documentation to support the request, ex:
sports schedule, note from parents/guardian etc.):
School-related scholastic activity or extra-curricular activity: __________________________________
Personal Illness or injury: _____________________________________________________________
Family Emergency: __________________________________________________________________
Other: ____________________________________________________________________________
If the Notice of Absence Form is submitted without supporting documentation to verify scholastic,
extra-curricular activity, illness or family emergency the absence will automatically be considered
unexcused. (See page 23 academic year handbook).
Examples of acceptable documentation include a current copy of sports schedule, note from teacher
or coach in charge of the school or sporting event, note from doctor, note from parent explaining
family emergency.
Absence due to work or participation in Driver’s Education will be considered unexcused.
Absence, excused or not, the participant is responsible for:
• making up any and all work assigned at the missed Upward Bound activity;
• retrieving assignments from the Upward Bound website, office or Program Coordinator; and
• completing and turning in assignments to Upward Bound no later than 10 calendar days
following the missed activity.
Failure to turn in missed assignments on time will result in disciplinary action
Participant Signature: ____________________________________________ Date: _____ /_____ / _____
Parent or Guardian's Name (please print): __________________________, __________________________
(Last) (First)
Parent/Guardian Signature: ________________________________________ Date: _____ /_____ / _____
FOR UPWARD BOUND USE ONLY:
Date Absence Form Received: _____ / _____ / _____ Excused Unexcused
Date Assignment Received: _____ / _____ / _____ Received by: _______________________________
8/17/15
