Notification of Class Absence for Flu-Like Illness
Upper Iowa University

This form is for students who have flu-like symptoms (coughing, fever, sore throat, vomiting, diahhrea, et al).  Once completed, please click the submit button at the bottom of this page.

Name:

Cell phone:

Room/Home Phone:

Email Address:

I had flu-like symptoms on the following dates:

Please provide any relevant details concerning your absence in the box below:

Do you have an underlying health condition and if so, what is it?

COMMUTER STUDENTS: To submit this form, scroll to the bottom of the page.

RESIDENCE HALL STUDENTS ONLY:  Sick Tray Request
Meals will be provided during regular cafeteria hours and delivered to your residence hall room.

Room Number & Building:

Meal Request (select all that apply):

Light Meal (liquids, broth, etc.)

Heavy Meal

Breakfast

Lunch

Dinner

Vegetarian

Allergies (please specify below)

Do you have a roommate? If so, what is their name?

Additional Needs/Specific Requests:

By clicking the submit button below, I verify that the information I have provided is true.  I recognize that falsifying this form is a violation of Upper Iowa University's Student Code of Conduct.