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)
Back to top
