Excused Absence Form – Personal Reason
Colorado School of Mines

This form should be completed by any student requesting an excused absence from classes due to illness,
bereavement, military service, jury duty, or other similar circumstances. The form should be completed and
submitted to the Student Life Office (Student Center, suite E240), or emailed to aomofoma@mines.edu

Student Information:

Student Name:


Phone Number:


Excused Absence Information:

Date(s) of the absence:

Reason for the excused absence request:

Please attach documentation regarding the absence (e.g., doctor’s note, hospital discharge papers, etc.)

Student Signature: