Request for Consideration of an Excused Absence

Request for Consideration of an Excused Absence

INSTRUCTIONS | Please complete this form if requesting consideration for an excused absence that will affect coursework. Students requesting an excused absence for a planned event should request in advance, have supporting documentation, and submit at least ten (10) business days, or two (2) weeks, prior to the requested date of absence.

Students will be notified by e-mail as to the status of the request.

After a request is approved, it is the student’s responsibility to contact the appropriate Curriculum Coordinator, Course Coordinator and/or faculty member(s) conducting lab/activity(s) on the day of the absence to arrange for make-up assignment(s) or date/time to complete testing.

Examples of approved reasons for absences can be found in the following link: https://tinyurl.com/noordaattendancepolicy

First and Last Name*

NoordaCOM Email*

Phone Number*

Phone

Academic Year

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Reason for Request

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Please List Your Emergency

Explanation for Request

First Date of Absence*

Last Date of Absence*

If you will only be gone for one day, please put your "Last Date of Absence" as the same date as "First Date of Absence".

Please check this box if your absence will be longer than 3 days

OMSI Coursework Affected

You may select mulitple

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OMSII Course Work Affected

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Other Course Work Affected

OMSIII Coursework Affected

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OMSIV Coursework Affected

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OMSIII Absence Request Options

Please click on the following link for an explanation of each request type:

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OMSIV Absence Request Options

Please click on the following link for an explanation of each request type:

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3rd Year Core Rotation

Please select the specialty so the correct clinical coordinator can be notified of your absence.

Family Medicine
General Surgery
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Psychiatry

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4th Year Clinical Coordinator

By checking this box, I understand that I'm responsible to email my coordinator. (Students can check Exxat to find their assigned clinical coordinator).

Supported Documentation

Illness, Conference Attendance, and Civic Responsibility MUST have supported documentation. Lack of documentation will lead to an automatic denial.

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