Request for an Excused Absence

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Dear Student,
 
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 and identity the graded assessment activity that will be impacted as well.  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!

 
Contact Information
Beginning Date of Absence?
Ending Date of Absence?
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
Cause for Absence
Please provide any additional information that may be relevant to this determination:
Identify all Course Code, Faculty and required assessment item(s) missed or conflicting with date of intended absence (i.e.: assignment deadline, exam/quiz, clinic rotation, mandatory attendance): 
Course Code, Faculty and Required assessment item missed (to be missed)
Course Code, Faculty and Required assessment item missed (to be missed)
Course Code, Faculty and Required assessment item missed (to be missed)
Course Code, Faculty and Required assessment item missed (to be missed)
I acknowledge that I have notified my faculty that I will be absence and will be submitting an excused absence request form.
Please upload your supporting documentation file below
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