Chapel Excuse Request Form

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Fields

Chapel Excuse Request Form

Name*

First Name*

Last Name*

CIU Email Address*

Student ID Number*

Permanent Chapel Excuse

If applicable, select from below to request Permanent Chapel Excuse:

I have no class before 4:00 pm on all three class days (Tuesday-Thursday) and live off campus. I request to be excused from chapel every day. I have no class before 1:00 pm on all three class days (Tuesday-Thursday) and live off campus. I request to be excused from chapel two days per week. (Select Days Below) I work during the chapel hour at least one day per week. (Select Work Days Below)

Work Days Requested

Monday Tuesday Wednesday Thursday Friday

*Additional Request Type

If applicable, select from below and provide date(s). *Date(s) are required to receive excused absence.*

Athletic Game Participation Which Require Absence from Chapel (*Game Dates Must Be Entered Below) Practicum/Internship/Class Participation Which Require Absence from Chapel (*Enter Dates Below) Extenuating Medical Need (6 or more consecutive absences needed) *Email supporting documentation to spiritualformation@ciu.edu Resident Assistant Room Checks (Enter Room Check Dates Below)

Date(s)

Month/Day/Year (Ex. Jan.1, 2020)

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