Use this form to report your child's absence to: .

PRIVACY INFORMATION: Transmission of information through this electronic form is between the user and appropriate Broward County Public Schools staff. Student identifying information is exempt from public records requests and will be redacted prior to releasing any records pursuant to a public records request.

1. Student First Name: *

Student First Name cannot be empty

2. Student Last Name: *

Student Last Name cannot be empty

3. Student ID: or Birth Date: *

4. Select a grade for school: {{SchoolName}} * -- Select a grade -- {{grade.Description}}
Grade cannot be empty

5. Date of Absence from: *


Date absence from cannot be empty.

6. Date of Absence to:

Date absence to cannot be empty.

7. Select a reason: * -- Select from list -- {{reason.AbsenceReason}}
Absence Reason cannot be empty.

8. Explanation (Please include student first name for multiple requests): *

Explanation for absence cannot be empty

9. Parent First Name (Reporting this absence): *

Parent first name cannot be empty

10. Parent Last Name (Reporting this absence): *

Parent last name cannot be empty

11. Parent's Email Address: *

Email is not valid

12. Parent's Phone Number: *

Phone number is not valid

13. Select a Phone Type: * -- Select from list -- Home Phone Work Phone Cell Phone
Phone type cannot be empty

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