Request to Miss Classes Step 1 of 4 - About You 0% I am a*Student requesting time away for myselfFaculty member requesting time away for my student(s)I am aFreshmanSophomoreJuniorSeniorReason For Absence:*Select ONLY One. "Pursuit of Excellence" requests are forwarded to the Academic Dean, "College Advising" requests are forwarded to the College Advising Office and "Other" are forwarded to the Dean of Students Office. Pursuit of ExcellenceCollege VisitOtherName*FirstLastEmail Address* Your Cell Phone Number:Please provide your cell phone number in the case of an emergency and Deerfield needs to contact you while you are awayReason for Request to Miss ClassesPlease explain why you are requesting to miss classes - please be as specific as possibleHave you previously submitted a Pursuit of Excellence request?*Student Requests must be answered Yes or No - Only faculty requests can be answered as N/AYesNoN/A (for faculty submissions only)How many class days during this academic year have you already used for a Pursuit of Excellence?*Please enter a value between 0 and 5.Have you allowed the required minimum of 10 days from request to event?*YesNoPlease explain why your request does not allow for the required 10 days review/approval time.*Deerfield or Personal Pursuit*A Deerfield Sponsored Event would be a team event or academic event ie: Ski Team Race, or Math Olympiad. Select OneDeerfield Sponsored EventPersonal Pursuit of ExcellenceName(s) of Student(s)Separate names with a commaI have discussed this visit with my college advisor*This request will NOT be approved if you have not previously discussed this visit with your advisor.Yes, I haveNo, I have notSTOP!! DO NOT CONTINUE FILLING OUT THIS FORM!!You must have discussed this with your college advisor PRIOR to submitting this form. Your advisor will receive a copy of this form.Thank you for discussing this request with your college advisor!Your College Advisor*Mr. AlbertsonMr. SpencerMs. BishopMs. LymanOtherCollege Being Visited:*How Many Class Days Have You Already Missed for College Visits?*Please enter a value between 0 and 2.How Many Days Are You Requesting?Remember - you are allowed a total of 2 days Please enter a value between 0 and 2.Event InformationEvent*What is the name of your event? ie: National Cartwheeling ChampionshipsEvent Location*ie: Silly Clown School in Laughing, Pennsylvania Departure & Return DetailsDeparture*On what date are you leaving? Departure Day*MondayTuesdayWednesdayThursdayFridaySaturdaySundayDeparture Time* : HHMMAMPMClasses Being Missed on the Day of DEPARTURE*Please indicate the class periods you will be missing on your departure day.All ClassesNo ClassesPeriod 1Period 2Period 3Period 4Period 5Period 6Period 7Return*On what date are you returning? Return Day*MondayTuesdayWednesdayThursdayFridaySaturdaySundayReturn Time* : HHMMAMPMClasses Being Missed on the Day of RETURN*All ClassesNo ClassesPeriod 1Period 2Period 3Period 4Period 5Period 6Period 7 Travel Details & Additional InformationWith Whom Will You Be Traveling?*FirstLastRelationship to StudentSelect OneDeerfield Faculty MemberDeerfield ParentOther - Explain in 'Additional Information' blockContact Phone Number*Please share the cell phone # of the faculty member or parent accompanying the student(s)Additional Information:*Please indicate: WHY this pursuit is important to you.. HOW you qualified for this.. WHAT do you hope to gain from this..