Attachment I





Student Name:   ________________________________ TxState ID______________________

                                       Print Name


Name of Organization___________________________________________________________




The above-named student will be involved in an officially-sponsored university event, and will be unable to attend the classes on the dates and times listed below. Please grant this student an excused absence for the class sessions indicated.


                                             Course                                    Class                     Dates

Course Name                      Number     Instructor            Meeting Time        of absence








This request must be signed by the advisor or director of the organization sponsoring this event.


________________________________Please print___________________________________

Signature, Advisor/Director                                        Full Name, Advisor/Director


Advisor e-mail__________________________ Phone #_____________Date_______________



Your absences during this university-sponsored function do not excuse you from completing all work associated with the classes that are missed. When you present this form to the instructor, you and your instructor should discuss the coursework for which you will be responsible upon your return. You are responsible for obtaining this information and completing the assignments in a timely manner. You or your instructor should keep the completed form to document your instructor’s approval of your request.



To verify the authenticity of this request, please go the website where you will find a listing of all officially-sponsored university events that have been registered. If an event is not listed, or if the form is not signed, this request may be invalid. Please reference UPPS No. 02.06.03 to review the official university policy. Questions may be directed to Student Involvement @ LBJSC at 512.245.3219.


________________________________Please print___________________________________

Signature, Instructor                                                   Full Name, Instructor