Secular Franciscan Order
St. Francis Region

Dispensation Form for Excused Absence

Name of Professed Member________________________________Date______________
Address____________________________________________Phone_______________

Please excuse me from attending our fraternity meetings. The reason I am unable to attend is:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I am requesting to be excused for:

Check one:    3 months____   6 Months________  9 months  _____       1 Year__________

Professed Fraternity Member Signature______________________________Date________

Name of Fraternity____________________________________________

City and State_______________________________________________

It is the responsibility of the professed member to renew this dispensation at the end of the period checked above, if necessary. You will remain on the rolls of the fraternity and be responsible for the financial and spiritual support of your fraternity during your dispensation.

Dispensation:		Granted_____       Denied_____       Date____________

Fraternity Minister Signature_______________________________

Entered into fraternity council minutes of meeting on_________________________