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First-Year Experience Seminar
Fall 2010:  59.109 – Sections 218, 206, 215, 202, 207, and 214

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Petition for Excused Absence

You may print this page or download and print the original form (Microsoft Word): Petition_for_Excused_Absence.doc

Petition for Excused Absence

This form must be completed if you either are planning to miss a scheduled class or if you have missed one.  Petitions will only be approved if you have a valid and adequately documented reason for missing the class.  If the petition is not approved, you may not be allowed to make up a missed assignment.  Be sure to attach to this form all appropriate supporting documentation, such as medical form, police report, letter from the athletic department, etc.
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TODAY’S DATE: ________________________________________________________

NAME: _________________________________________________________________

INSTRUCTOR: __________________________________________________________

CLASS SECTION NUMBER:_________________________CLASS TIME: _________

DATE OF ABSENCE: ____________________________________________________

REASON FOR ABSENCE (Please check as appropriate):

____ Medical Issue     ____ Accident     ____ Family Issue      ____ Religious Obligation

____ UMass Lowell-Sponsored Event (If so, please indicate which one.)
            ____ Athletic ____ International Relations ____ Art Club
            ____ Language Club ____ Music ____ Other (If other, please list.) ___________

EXPLANATION of your reason:  (Please be brief, but clear.)
________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

Indicate the DOCUMENTATION you are providing to support your petition:

This document is (please check one): ____ an original ____ a copy

 

“I declare that the information provided on this form is true and accurate.”

 

Signature: __________________________________________        Date: _____________