DLI: O19395639759

STUDENT ABSENCE REQUEST FORM

This form should be completed by any student requesting an excused absence from classes/exams due to illness,
bereavement, jury duty, or other similar circumstances. Please submit your absence report as far in advance of your
absence date and as soon as you know you will be absent. It is your responsibility to inquire about and make up for
any assignments/exams missed due to this absence.

The form should be completed and submitted to the Admission Office admission@quantumedu.ca

Student Information

Student Name: Student ID:

Email: Contact Number:

Excused Absence Information

Course Name:

Date(s) of the absence Exam Date:

Reason for the excused absence request:

Absence Detail

Please attach documentation regarding the absence. Such as a doctor’s note, hospital bill, etc.

Signature of Instructor Date

Student Signature Date

FOR OFFICE USE ONLY

Decision:
Request Approved

Admissions Manager Signature: Date: