Office of Professional Programs

Pre-Clinical Student Absence Form

Absence Form

Student Name *

First and Last Name

Student Email Address *

Class year *

VME I

VME II

VME III

Name of Course(s), Instructor, and Task(s) Missed

Type of Absence *

Planned

Unplanned

Reason of Absence

Please provide additional details describing your situation *

Missed Course *

Authorizing Faculty/Team Leader Name *

Authorizing Faculty/Team Leader OSU Email *

This must be the team leader's OSU email address

Missed Task *

Graded Assignment

Exam

Laboratory

Other

If other, please specify

Date of Missed Task *

Month

Day

Year

Additional Comments