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Notification of Class Absence for Flu-Like IllnessUpper 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.
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 RequestMeals will be provided during regular cafeteria hours and delivered to your residence
Room Number & Building:
Meal Request (select all that apply):
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.
Upper Iowa University 605 Washington Street | P.O. Box 1857 Fayette, Iowa 52142 | 800.553.4150 email@example.com | © 2016-2017 Upper Iowa University All Rights Reserved