ACT 1776

Exhibit B

Teacher Absence Form

I will be absent on _________________________________________________
(date)

I was absent on ___________________________________________________
(date)

I was absent on _________________ for periods _________________________
(date)

Please check one of the following:

1. Sick Day(s) ______ Sick Day(s) (Family Emergency) ___________________

2. Personal Day(s) ______

Urgent business ______ Emergency ______ Honeymoon _____

3. Funeral Day(s)

Immediate Family ___________________________________
(Article VI, Section 4)

Relation as defined in Article VI, Section 5 ______________________________

4. Other (specify) _________________________________________________

Date ___________________ Signature _______________________________

This Form is to be Returned Within Forty-Eight Hours of the Teacher's
Return to School (Article VI, Section 6)

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