Republic of the Philippines

DON HONORIO VENTURA STATE UNIVERSITY

Villa de Bacolor, Pampanga

College of Education

ABSENCE EXCUSE FORM

Date: November 22, 2023

Student Name: Jenica A. Santos

Program, Major, Year and Section: BTVTED, FSM 3-A

Date (s) of Absence: November 20-22, 2023

Reason for absence: Please excuse my sister Jenica A. Santos for not attending your class for

three consecutive days because she had flu. Thank you for your consideration.

Note: Pls attach any additional documentation (medical cert., physician’s letter, etc) if applicable.

Student’s Signature:

Parent/Guardian Name and Signature: JANE CATHERINE A. SANTOS

Contact Number : 09365757106

Note: Pls attach photocopy of ID of the student and the parent/guardian (preferably ID with signature)

Class Adviser Name and Signature:

Approved: Yes No
Reason if not approved: _________________________________________________

Noted:

ANALAINE G. LAXAMANA, EdD

Program Chairperson, BTVTEd and BTLEd Programs