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BVUSD ABSENCE REPORTING FORM
If you have more than one student absent, please complete a form for each student.
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* Indicates required question
Student FIRST
*
Your answer
Student LAST
*
Your answer
Student's SCHOOL
*
Yulupa Elementary (TK-3rd)
Strawberry Elementary (4th -6th)
Student's TEACHER
*
Your answer
Date(s) of absence
*
Please list all dates of known/planned absence.
Your answer
Reason for absence
*
If 'OTHER,' please enter reason.
Illness
Medical Appointment
Religious holiday
Family Emergency
Family Trip/Activity
Other:
Is there any additional information about the absence?
optional response
Your answer
Name of Person Completing the Form
*
Your answer
Relationship to Student
*
Parent/Guardian
Other:
Phone Number
*
Your answer
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