Official Excuse Request Form

GUIDELINES FOR REQUESTING EXCUSED ABSENCES

We expect pharmacy learners to have responsible behavior at all levels; consequently, excused absences are issued to learners to prevent negative academic repercussions from a legitimate life event. This form is not designed to accommodate students who have not acted responsibly.

The following guidelines are used in determining the appropriateness of an excuse being issued:

Learners should notify their advisor/counselor concerning any event that may cause absences from any class, lab, or scheduled session. This notice should occur as soon as the learner is aware of the event.
Learners must electronically submit a request(s) for an excused absence(s) within 48 hours of return to school. Submissions after this period may or may not be considered.
The learner must also submit a hard copy and the original documentation to their Advisor/Counselor within 48 hours of return to school.
To receive consideration for an excused absence(s) for illness, the learner must submit the following:
- An original signed and dated doctor's statement from a doctor or clinic official on their official letterhead is required for all scheduled exams and assignments. It must be submitted to the advisor/counselor within 48-hours after the learner can physically return to school.
- If there is an illness or death of one's family member(s), the advisor/counselor should be notified as soon as the learner becomes aware. The office can assist them with any academic or personal arrangements to facilitate their continued positive academic performance.
All requests for excused absences must be submitted directly to the student's advisor/counselor. The request will be processed and forwarded to the Assistant Dean of Student Affairs for final approval.
A copy of the excuse will be placed in the learner's file, and the original will be given to the learner to submit to their instructor(s). It is the learner's responsibility to follow up with their advisor/counselor regarding the status of their excuse.
Instructors will not allow learners to make up assignments or exams without an approved excuse.
Excuses may be picked up within two-three business days.

NOTE: ORIGINAL DOCUMENTATION MUST ACCOMPANY EACH REQUEST. Once this form is submitted, email your original documentation to your advisor/counselor. Remember that submitting false, inaccurate, or altered documents will be considered a severe offense and will be treated as such.

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Today's Date

Date*

Name of Advisor/Person Assisting

Please Select

First and Last Name

Name*

Student ID Number

ID Number*

Email

Email Address*

Phone Number

Phone Number*

Academic Level

Academic Level

Initial Date and Time Absent

Date and Time*

Last Date and Time Absent

Date and Time*

Reason for Absence

Reason for Absence*

If "Other" Reason for Absence, Please Specify

Please choose one. If you have multiple causes of missing the class, please select "other" and list them under the "other " section.

Absence(s) caused me to miss the following *

If "Other" Cause for Absence(s), Please Specify

List Instructor(s) and Course(s) Missed

1. Instructor and Course Prefix/Number (Example: PHA 1001)*

2. Instructor and Course Prefix/Number (Example: PHA 1001)

3. Instructor and Course Prefix/Number (Example: PHA 1001)

4. Instructor and Course Prefix/Number (Example: PHA 1001)

5. Instructor and Course Prefix/Number (Example: PHA 1001)