REQUEST FOR PRIOR APPROVAL OF SCHOOL ABSENCES(S) (7-5-12)
INSTRUCTIONS: All sections of this form must be completed. Parental/guardian permission letter must be attached to this form for all
absence requests that are not school sanctioned activities. Request for Prior Approval forms must be submitted two (2) school days prior to
the date of the absence or five (5) days prior notification for a lab class. Failure to submit your completed form 2-5 days prior to your
absence may result in your request being denied. Return this form to the Academic Programs Office (Watts 101) or to the
Textbook/Attendance room adjacent to the Cafeteria. Parent Permission letters can be faxed to the Attendance Coordinator at
(919) 416-2890. If you have questions send an email to absence@ncssm.edu (Class Attendance).
DOES THIS ABSENCE INVOLVE INTERNATIONAL TRAVEL
YES
Name:
Grade:
Residence Hall/Room #:
Campus Mailbox #:
Date(s) of Absence(s):
Today’s Date
Departure Date:
Departure Time:
am / pm
Return Date:
Return Time:
am / pm
Specific Reason for Absence(s):
COMPLETE THIS SECTION IF THE ABSENCE IS A SCHOOL SANCTIONED ACTIVITY
Name of Event / Activity:
Name of Adult Sponsor:
Time student will be excused from class for departure:
am / pm
STUDENTS: List all classes including seminars, independent studies, mentorship, SL101/102, work service and all other required activities
that will be missed during this/these absence(s), list the class block, and then circle the corresponding day(s) that class(es) will be missed.
You are required to get all of your teacher’s signatures for classes that will be missed.
TEACHERS / WORK SERVICE SUPERVISOR: Please sign on the appropriate line and indicate any reservations that you may have
about this students’ absence(s) from your class(es) or work service on the date(s) specified above. If you have not reservations, print
“NONE”. Absences about which reservation is expressed will not be approved.
Course
Title
Class
Block
THIS REQUEST IS:
S
S
S
S
S
S
S
S
S
S
S
Day(s) Absent
(Circle all that apply)
M
M
M
M
M
M
M
M
M
M
M
T
T
T
T
T
T
T
T
T
T
T
W
W
W
W
W
W
W
W
W
W
W
TH
TH
TH
TH
TH
TH
TH
TH
TH
TH
TH
 Approved
F
F
F
F
F
F
F
F
F
F
F
S
S
S
S
S
S
S
S
S
S
S
Reservations About Approval
(if none, print “NONE”)
Excused
Signature
 Unexcused
THIS REQUEST CANNOT BE PROCESSED BECAUSE OF INSUFFICIENT INFORMATION:
Need Parent Permission Letter
Attendance Coordinator
 Need Signature(s)
Date
 Form Incomplete
Director of Academic Programs
Date