Upward Bound - Absence Request

ALL EXCUSED ABSENCES MUST BE APPROVED BY THE UPWARD BOUND MANAGER.

Please list all dates that your student will be absent during the summer program. If you are unsure of when some absences may be, such as summer camps, please estimate approximately when you believe you may be absent in order to make the paperwork deadline. You can complete another form at a later date in order to update us with more accurate information. Please let us know AS SOON as you get finalized information.

Excused absences include:
• Summer School (Drivers Ed, etc.)
• Doctor/Dental Appointments
• Pre-arranged Family Commitments

Unexcused absences include:
• Hair Appointments
• Personal Appointments
• Work - Your work schedule needs to be approved through the UB Manager

Student Name Student Name First Last
Date of Absence Date of Absence / MM / DD YYYY
Time Student is Expected to Leave Time Student is Expected to Leave : HH MM AM/PM
Time Student is Expected to Return Time Student is Expected to Return : HH MM AM/PM
Reason for Absence
Parent's / Guardian's Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY