Request for Missed Class

Name (Print):___________________________________________________________________

Course:________________________________________________________________________

Class Date:_____________________________________________________________________

Reason for missing class. (Give the reason the class (or classes) was missed. Attach any additional information to this form you feel is pertinent. You may continue your reason on the back of this form.)

List all other classes at JSU missed due to the reason given above.

______________________________________________________________________________

______________________________________________________________________________

My signature below certifies that the information given above is true and accurate to the best of my knowledge.

Signature:______________________________________________________________________