Request for Excused Absence/Missed Testing
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Hello,
Please complete this form only if you require an excused absence to reschedule missed testing or to fulfill an attendance requirement.
Please complete the form in full. Incomplete forms will not be processed.
Disputes over excused absences should be directed to the Dean of Students.
Contact Information
First 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
01
02
03
04
05
06
07
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28
29
30
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
26
27
28
29
30
31
Year
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Long-term Absence: If you will be missing more than a week of classes, please contact the Dean of Students at (480) 222-9237 to discuss options for making up missed work.
Reason for Absence
Accident
ADA related symptoms
Bereavement (Death)
Family emergency
Illness
Jury duty/legal proceedings
Major religious holiday
Medical appointment
Official leadership capacity
Presentation at a professional conference
Technical issues
Other
Describe:
Describe:
Describe:
Describe:
Please provide a brief description of the reason for absence:
Please list all classes missed by Faculty Name(s), Course Code #, Day of Class, and Time of Class:
Are you missing any exams, tests, quizzes or assignments during your absence?
Yes
No
Please list missed exams or assignments by Fa
culty Name(s), Course Code #, and Type of Exam Missed:
Will you be missing more than two days?
Yes
No
Please describe supporting documentation you are attaching.
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