ATTENDANCE APPEAL FORM
Date______________
Student Name__________________________________________ Grade_____________
Student Number_______________________________________
Date(s) of Absence(s) Class
Periods Missed Reason for Absence*
(Use back if more space is needed)
_________________ ___________________ ________________________
_________________ ___________________ ________________________
_________________ ___________________ ________________________
_________________ ___________________ ________________________
_________________ ___________________ ________________________
*Please attach supporting documentation (i.e. Doctor’s
note, letter explaining events, etc.)
Name of Parent/Guardian__________________________________________Day
Phone_______________
Parent/Guardian
Signature_________________________________________Date____________________
PLEASE NOTE THAT SUBMISSION OF AN APPEAL DOES NOT
GUARANTEE THAT ABSENCES WILL BE CLEARED.
STUDENT SHOULD CONTINUE ATTENDING ARC IN CASE THE APPEAL IS DENIED.
Return Form to Timpanogos Attendance Office when
completed
*************************************************************************************
FOR OFFICE USE
Date Appeal was
received_______________________________________________________
Appeal has been: GRANTED DENIED PARTIAL GRANTED
Administrator
Signature__________________________________________________Date_____________
COMMENTS:__________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
o
Parent/Guardian
Contacted/Date_______________
o
Student
Contacted/Date______________________
o
Teachers Emailed/Date_______________________