Occasionally, students will miss assessments (for legitimate or illegitimate reasons). When a student writes a make-up exam, I have them fill out this form to keep on file. If the absence was excused, they can skip the "alternative to zero score" consequence section. If the absence was unexcused, they have to identify a more appropriate consequence than receiving a zero score and have their parents/guardians sign off.
Included on the form:
-"The Basics" (name, date of original test, etc)
-"Reflect" (why did they miss the original assessment, alternative consequences if necessary)
-"Request" (short blurb about consequences of missing assessments- i.e. referral to counsellor/administration)
-Spaces for student and parent/guardian signatures at the bottom
I have left this in Word Document format so that it can be adjusted and personalized!