College of Medicine / Students / Reporting

Special Request for Absence from an Educational or Clinical Responsibility

This form must be submitted for an anticipated absence to all of the student’s current Course Directors or Clerkship Directors affected by the absence a minimum of 4 weeks prior to the event.


NOTE: Students should complete and submit one form and list all Course Directors and/or Clerkship Directors affected by the absence.  You will receive notification from your Course/Clerkship Director on whether your absence is excused, unexcused or if they need further information.


Last Modified 8/2/18