INSTRUCTIONS

1. This form is required only if a student is absent from required and graded coursework, activities, assignments, and programmatic requirements.
2. Review the school’s Absence Policy.
3. Complete all sections of this form and attach supporting documentation before submitting the form.
4. For absences requiring preapproval, this form must be submitted at least 30 days in advance of your absence(s).
5. In cases of medical emergency, contact sop.oss@cuanschutz.edu as soon as possible and submit this form within 24 hours of your absence(s).

STUDENT INFORMATION

Date(s) sought to be absent from class:

Please explain the reason for requesting an absence(s) and attach supporting documentation. See the bottom of this form for examples of acceptable forms of documentation.

MISSED WORK REQUIRING AN ABSENCE(S)

Please provide full course name and number, assessment/activity title, dates and times, and full name of course director(s).

IMPORTANT NOTES

• OSS will evaluate whether the requested absence is:

A) Absence protected by law

B) Absence managed at the course level

C) Unapproved absence

• You will be copied on an email that will be sent to the course directors confirming the decision.  
• If allowed under the Absence Policy or via course syllabus, students are responsible for working directly with Course Directors to understand how missed work will be managed.

Acceptable Forms of Documentation

The following represents examples of acceptable documentation that may support the reason for your absence(s). All documentation must contain identifiable information including student’s name, dates of absence, etc. Please note that documentation must reflect/align with the date of absence.

It is important to recognize that these are examples and OSS will evaluate individual circumstances to determine if submitted documentation is sufficient. Please note, students have a right to privacy when seeking care and are therefore not required to disclose specific diagnosis and/or type of healthcare that is being sought.

• Disability related absences
  • Faculty Notification Memorandum (FNM) from ODAI
  • Medical statement from a provider on official letterhead

• Absences due to court mandated appearance
  • Copy of jury summons received.
  • Certificate of service from the court confirming appearance on the date reflected in the summons.
  • If selected, a certificate of service from the court documenting dates of service.
  • Other court summons, subpoena/trial documents, etc. with identifiable information.

• Preapproved professional activities:
  • Support from the student organization advisor(s)
  • Confirmed conference registration.
  • Flight itinerary or hotel reservation confirmation

• Observance of Religious Holidays
  • Official document from religious leader confirming dates of religious observance.
• Pregnancy related absences
  • Medical statement from a provider on official letterhead
• COVID-19 related absences
  • PCR test results (rapid/home tests will not be accepted)
  • Medical statement from a provider on official letterhead

• Absences due to medical necessity:
  • Medical statement from a provider on official letterhead
  • Appointment records
• Death/Bereavement:
  • Copy of obituary, service program, or statement from a funeral official on official letterhead
  • Flight itinerary (if applicable)
• Weddings:
  • Invitation, ceremony program, newspaper announcement
  • Flight itinerary (if applicable)

For all other types of absences, or if you have any questions, please contact sop.oss@cuanschutz.edu for assistance in determining acceptable forms of documentation.

DOCUMENTATION UPLOAD (REQUIRED)

STUDENT CERTIFICATION and ACKNOWLEDGEMENT

By signing below,

• I certify that I have read, understand, and followed all requirements in the school’s Absence Policy. I have not misrepresented or falsified any facts, circumstances, documentation, or other information provided to my course directors or OSS which has formed the basis to support my request for an absence(s).
• If making up an exam or quiz at a separate time than the rest of my class, I hereby acknowledge that...
  • I have not misrepresented or falsified any facts, circumstances, documentation, or other information provided to my course directors or the Offices of Student Services which have formed the basis to authorize my excused absence from the exam, quiz, or other evaluation.
  • I have not received any information regarding the content of the exam/quiz directly, indirectly, or inadvertently from any classmate or other individual, or through any other communication mechanism, including, but not limited to, social media.
  • I have not sought or elicited any information regarding the content of the exam/quiz from any classmate or other individual, or through any other communication mechanism, including, but not limited to, social media.
  • I will not disclose or share any content or other information related to this exam/quiz to my classmates or other individuals directly or indirectly, through any communication mechanism, including, but not limited to, social media.
  • A violation of these terms may result in the submission of an incident report under the Student Ethics and Conduct Code (SECC) and I will be subject to the process under the SECC and/or any other applicable school or university policies or procedures.
  • I have a continuing duty to self-report any violations of these terms by completing an incident report under the SECC.
  • Any final determination that I am in violation of the SECC and/or any other applicable school or university polices, or procedures may subject me to disciplinary sanctions, including, but not limited to, receiving an F grade for the assessment and/or suspension or expulsion from the Pharm. D. program.
  • I have read, understand, and had my questions answered regarding these terms and my obligations.