UAC

Your First Name*: Your Last Name*:

Email*: Phone Number*:

You are*: An UAC Student A Volunteer

Date of Absence: Time of class: AM PM

Class Location
(bldg and room#):

Individual who was
or will be absent: The Volunteer The UAC Student

Was 24-hour notice given? yes no

Reason for Absence:

**REMEMBER, UAC students receiving service are only allowed 3 unexcused absences**