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Cleveland City School District
Statement of Absence (Sick Leave) Form
10/18/2019

Reason for Absence:


I. Sick Leave:
Personal Illness:  

Dates of Personal Illness
Half Day:
Yes  No  
Illness or Death in Family:  

Dates of Family Illness

Relationship
Bereavement (Certified Staff Only):  

Dates Used
Substitute Name:
Please enter the name of your substitute if applicable.
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