ACTIVITY ABSENCE APPLICATION

Social Work Program

University of North Carolina At Pembroke

Pembroke, NC 28372

Date ________________________

 

_________________________________________ will be representing the University of North Carolina at Pembroke                          (Name - Print or Type)

at _____                                                          ___________ for ____________________________________________                                                                                       (Place)                                                                                                      (Activity)

 

from ________________________  on ________________________                     ______                                                            (Time)                                                   (Date)

to __________________________    on __________                       __________________ .
                                    (Time)                                                  (Date)         

 

Professor's Signatures and Date

 

1. __________________________________________             _______________             ______________________
                                                                                                                           Student’s Signature     

2. __________________________________________                                            ____________________________                                                                                                                    Sponsor’s Signature     

3. ___________________________________________             __________                                 ________________
                                                                                                                Vice Chancellor of Student Affairs
4. ___________________________________________

5. ___________________________________________

6. ___________________________________________

 

*Invalid unless completed and returned to Office of Student Affairs prior to scheduled activity.