1. ABSENCE FROM CLASS/DUTIES REQUEST
      2. Name:       Division:
      3. Date of Absence Requested:
      4. Course # & Section:      Time:   Bldg./Room#:
      5. CLASS WILL BE COVERED BY:
      6. DUTIES TO BE MISSED:

 

 

 


ABSENCE FROM CLASS/DUTIES REQUEST

 


Name:            Division:

 


Date of Absence Requested:

 


Course # & Section:          Time:    Bldg./Room#:

 

 


CLASS WILL BE COVERED BY:

 

  Colleague Division Dean   Media Presentation Guest Lecturer

 

 Combining Classes   Paid Substitute    Special Class Assignment

 

 

Students will be notified:

Date By Whom

 


DUTIES TO BE MISSED:

 

  Office Hours Registration Scheduled Meeting

 

  Advising   Graduation Other:  

 

Have any arrangements been made to cover your duties?

 

  Yes If Yes, by whom?

  

  No If No, reason for missing duties:

 

 

If this was an unplanned absence and you were unable to notify the College, please explain why you were absent.

 

 

 

 

 

 

 

 

 

Requested By Approved By:

 

____________________________________ __________________________________

Employee’s Signature   Date      Supervisor’s Signature Date

 

Form 1502/003 (3/05)

 

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