Absence Approval Form
This form must accompany the Community Engagement Mini-Grant Application Form if
participation in the relevant program or event will result in absence from any scheduled class.
Please submit only one Absence Approval form per course.
I.
CLASS CONFLICT INFORMATION:
Student:
Course:
Professor:
Number of Classes Missed:
Proposed Absence Date(s):
Reason for Absence:
Brief Description /
Reason for Attending:
For your professor’s benefit, briefly
describe the program or event listed above
and explain your personal and/or
academic reasons for attending the event
II.
(Write program or event name here)
FACULTY AUTHORIZATION
I have read the above-listed “Class Conflict Information” and I authorize this student to be
absent from my class on the date(s) indicated.
Professor Signature: _____________________________________
Date: __________________________________________________
Note to Faculty: If you would like additional information about the above event or would
like to discuss any reservation you may have about the proposed absence, please feel free to
contact Community Engagement Associate Director Ashley Laux, 802-443-3099,
alaux@middlebury.edu.