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 Excellence College Visit Other - Please note that any absence related to medical issues (such as doctors’ appointments, injury, surgery, or chronic illness) must be approved through the Health Center. Name* First Last Email 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 possible Have 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 3 days from request to the day of your departure?* Yes No Please 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 comma I 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. Washburn Mr. Spencer Ms. Tarrant Madden Ms. Lareau Ms. Bucci College 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?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* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Departure Time* : HH MM AM PM Classes Being Missed on the Day of DEPARTURE*Please indicate the class periods you will be missing on your departure day. All Classes No Classes Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Return*On what date are you returning? Return Day* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Return Time* : HH MM AM PM Classes Being Missed on the Day of RETURN* All Classes No Classes Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Travel Details & Additional InformationWith Whom Will You Be Traveling?* First Last Relationship to Student - select from drop downDeerfield 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..