Directed Teaching Absence Report Form (DT-4)

Please NOTE: This form will NOT SAVE if you begin it now and return later to finish and submit. Please complete and submit the form in one session.

Once submitted, copies of the form will go to the teacher candidate, the cooperating teacher, the university supervisor.

* Date:

* Teacher Candidate:

* Email:

* School:

* Cooperating Teacher:

* Cooperating Teacher Email:

* University Supervisor:

* University Supervisor Email:

* Date of Absence:

Reason for Absence:

Date of Absence:

Reason for Absence:

My University Supervisor approves this absence *

If Other, explain here:

My Cooperating Teacher approves this absence *

If Other, explain here: