Request for an Excused Absence
Exit Survey
Questions marked with a
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are required
90%
Dear Student,
ENTIRE PROCESS MUST COMPLETED WITHIN 24 HOURS OF OCCURANCE UNLESS INCAPACITATED*, OR IN CASES OF BEREVEMENT OF IMMEDIATE FAMILY MEMBERS
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Please complete this form to request review by the Dean of Students Office, for an Excused Absence, for instances where you have or will miss an assignment deadline, exam or quiz, clinic rotation, mandatory course attendance, or any other required graded assessment activity per your course syllabus. Emails to the Dean's Office or to faculty will not be accepted in lieu of this form. This form must be completed in full to be processed. Documentation, where identified, is required.
Step 1- Faculty Notification:
Students must notify their faculty, as per the requirements identified in the course syllabus (Phone, email, Canvas notification, etc.), immediately about your absence.
NOTE: Submission of this form does not meet this requirement
. Identify to faculty that you are submitting a request to the Dean of Student’s office from review. If provided an excused absence you will need to work with faculty to determine how to achieve course requirement in a timely fashion.
Step 2 - Submit Request to DOS for Review:
Complete and submit the form below. The Dean of Students decides as to whether the absence meeting policy criteria, and will notify you and your faculty of the outcome.
NOTE: Faculty, at their discretion, determine the student’s eligibility to receive a makeup exam or an extension on any graded assessment activities based upon the provisions of the course syllabus.
You do not need to fill out an excused absence if you will not be missing any graded assessment activities. If you have any question about the policy or the process, please feel free to contact the Dean of Students at
DOS@scnm.edu
.
For more information on Excused Absences, please refer to the
Student Handbook on MySCNM
and individual course syllabus. Thank you!
*Incapacitation occurs when a student is completely impaired, helpless, and unable to perform any functions for themselves or mentally make any decisions or interact with others. Incapacitation may also occur when student is physically restricted from any means of communication with the school due to occurrences such as hospitalization, communications blackout due to natural disaster, or similar physical restrictions not under direct control of the student.
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Bereavement is normally limited to three days unless an immediate family member or other extenuating circumstance that requires additional time to finalize arrangements. Please identify the situation with the Dean of Students in your request. Notification to DOS may exceed 24 hour time limit depending on the situation
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Contact Information
Full Name
Last Name
Phone
SCNM Email Address
Student ID #
Beginning Date of Absence?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
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31
Year
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Ending Date of Absence?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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28
29
30
31
Year
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Note: If you will be missing several days (3 days for Masters program students or 5 days for Doctorate program students), please contact the Dean of Students at (480) 222-9237 or DOS@scnm.edu to discuss the specifics of your situation and various options including Add/Drop, Withdrawal from a class, term, or session, a Grade of Incomplete, or a Leave of Absence.
Reason for Requested Absence
Unable to meet attendance requirement
Will be unable to meet attendance activity requirement
Missed an exam/quiz
Will miss an exam /quiz
Missed a graded in class activity
Will miss a graded in class activity
Missed an assignment deadline
Will miss an assignment deadline
Cause for Absence
Accident (documentation required)
Acute medical illness (documentation may be required)
ADA related symptoms
Bereavement
Family Emergency (documentation required)
Major religious holiday (Religious Exemption on file in Dean's Office required)
Medical appointment (documentation required)
Presentation at a Professional Conference (Pre-approval of Program Dean required)
Technical Issues (IT Notification required)
Wedding - Self, immediate family, wedding party only (Invitation required)
Brief Description:
Identify diagnosis or condition:
Identify symptom and severity:
Please indicate if immediate family, extended family or acquaintance
Identify Emergency:
Identify holiday:
Identify why appointment could not be scheduled around course requirement:
Conference Name:
Describe issues and IT response to problem:
Define involvement with this wedding:
Please provide any additional information that may be relevant to this determination:
Identify the Course Code, Faculty name and required assessment item missed or to be missed (i.e.: assignment deadline, exam/quiz, clinic rotation, mandatory attendance)
Please use one line per entry
:
Course Code, Faculty Name and Required assessment item missed (to be missed)
Course Code, Faculty Name and Required assessment item missed (to be missed)
Course Code, Faculty Name and Required assessment item missed (to be missed)
Course Code, Faculty Name and Required assessment item missed (to be missed)
I acknowledge that I have notified my faculty that I will be absent and will be submitting an excused absence request form.
Yes
No
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