ASU-OSA Form 1

Series Code: 000101

Date: Nov. 2, 2015
Republic of the Philippines
AKLAN STATE UNIVERSITY
Guidance and Counseling Services Office

_______________________
Date

STUDENT EXCUSE SLIP

The Guidance Counselor

Aklan State University – Kalibo Campus

SIR,
Please excuse me for being absent from the following classes for these reasons:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________.

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Student’s Printed Name & Signature/Course
NOTED: _____________________________
Printed Name & Signature of Parent

EXCUSED UNEXCUSED TEACHER’S DISCRETION TO EXCUSE OR NOT FOR ADMISSION

KIM G. YABUT, MAEd, RGC

Guidance Counselor II

CLASSES DATE TEACHER’S SIGNATURE

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_____________________ _______________________
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CERTIFICATION DUE TO ILLNESS

To Whom It May Concern:

This is to certify that ________________________________________ was treated for

___________________________________from ________________________inclusive.

REMARKS:
____________________________________________________________________________
____________________________________________________________________________.

________________________________
Physician