Self Certificate

Self Authorised Absence
To be completed by student
Student Name
Student Number
Date Of Birth

MonthDayYear
Course Title
You should complete this certificate if you are absent for a period of up to 7 consecutive days (5 College days). Please show all the dates you did not attend College, if you were absent for AM, PM or both. You should select one of the reasons why you were absent .
Date

MonthDayYear
AM / PM
Reason for Absence
Date

MonthDayYear
AM / PM
Reason for Absence
Date

MonthDayYear
AM / PM
Reason for Absence
Date

MonthDayYear
AM / PM
Reason for Absence
Date

MonthDayYear
AM / PM
Reason for Absence
I Declare that this information is accurate and I understand that if I give false information my bursary / EMA award may be cancelled and if necessary, action will be taken against me to recover any money paid to me by the college.
Should be Empty:

Self Authorised Absence