Notice of Class Absence Due to Student Activities Sponsored Travel
Student Name
*
First Name
Last Name
PBSC Student ID
*
Student Email
*
example@my.pbsc.edu
Dates of Absence
*
Reason for Absence
*
Club/Organization Name
*
Club Advisor Name
Club Advisor Email
username@pbsc.edu
How many courses will you miss?
*
Please Select
1
2
3
4
5
6
7
8
1. Instructor Name
*
1. Instructor Email
username@pbsc.edu
1. Course ID (example: MAT1033C-2)
2. Instructor Name
*
2. Instructor Email
username@pbsc.edu
2. Course ID (MAT1033C-2, ENC1101-3, ...)
3. Instructor Name
*
3. Instructor Email
username@pbsc.edu
3. Course ID (MAT1033C-2, ENC1101-3, ...)
4. Instructor Name
*
4. Instructor Email
username@pbsc.edu
4. Course ID (MAT1033C-2, ENC1101-3, ...)
5. Instructor Name
*
5. Instructor Email
username@pbsc.edu
5. Course ID (MAT1033C-2, ENC1101-3, ...)
6. Instructor Name
*
6. Instructor Email
username@pbsc.edu
6. Course ID (MAT1033C-2, ENC1101-3, ...)
7. Instructor Name
*
7. Instructor Email
username@pbsc.edu
7. Course ID (MAT1033C-2, ENC1101-3, ...)
8. Instructor Name
*
8. Instructor Email
username@pbsc.edu
8. Course ID (MAT1033C-2, ENC1101-3, ...)
Club Advisor Signature
*
Notes:
Submit
Should be Empty: