Verification of Student Absence Request from Faculty

If you would like information about a student who was absent from your class due to injury or illness, you must first request that the student complete a release form authorizing you to receive this information. You may then submit this form to Dr. Steven Radi, Medical Director for Health Services. Please be sure that you have filled in your name and contact information, the student's name, and the dates of absence.

Dates of Absence

2 + 9 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.