Please print this form, fill it in completely, and hand it over to the course instructor. Do not e-mail the form.

Students who are ill for a week or longer must attach a written note from the Health Center or personal physician (on the doctor's letterhead) detailing the nature and the duration of the illness.

I was unable to attend the (check one)

___ discussion session

___ seminar session

on__________________________________________________

due to an illness of such severity as to prevent me from attending.
I was ill from

(time and date)_________________________________________

to (time and date)_______________________________________

I pledge on my honor that all statements on this form are true.

Signature______________________________________________

Last name, First (PRINT)_________________________________

Student ID No._________________________________________

I am enrolled in ARCH _______, Section No._________________