NORTHWEST MISSISSIPPI COMMUNITY COLLEGE
 PERSONNEL FORM X
 ABSENCE REPORT

Employee Name
Division   Northwest ID#
Personal Illness
National Guard/Reserve Duty
Personal Leave
Jury Duty
Accident on Job
Suspension
Leave Without Pay
Family Death
Accrued Comp Time
Illness in Immediate Family
Approved School Travel
Other (please explain)



Dates absent    Total Days Absent

Classes missed (for Faculty Only) List each class missed.


Course Building/room no Day/Date  Hour 

Course Building/room no Day/Date  Hour 

Course Building/room no Day/Date  Hour 

Course Building/room no Day/Date  Hour 

Course Building/room no Day/Date  Hour 

Course Building/room no Day/Date  Hour

Course Building/room no Day/Date  Hour 
Classes will be covered by another instructor?  Yes No  
Name of instructor covering classes 


Supervisor's Approval
Was employee's absence:
     Approved in advance (if required) Yes No   Not applicable
     Reported in advance or on 1st day of return Yes No
     Considered by Supervisor as Approved  Not Approved
Signatures
Employee ___________________  Date ________  Supervisor ___________________ Date_______

Dean    _____________________  Date ________  President/VP _________________ Date_______